Healthcare Provider Details

I. General information

NPI: 1114620861
Provider Name (Legal Business Name): HAYAT LAKLUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 MAIN ST
PATERSON NJ
07503-3028
US

IV. Provider business mailing address

661 MAIN ST STE 202
PATERSON NJ
07503-3028
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-4525
  • Fax:
Mailing address:
  • Phone: 973-754-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: