Healthcare Provider Details

I. General information

NPI: 1417635772
Provider Name (Legal Business Name): JACQUELINE LAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W GERMANTOWN PIKE
EAST NORRITON PA
19403-4243
US

IV. Provider business mailing address

609 W GERMANTOWN PIKE
EAST NORRITON PA
19403-4243
US

V. Phone/Fax

Practice location:
  • Phone: 484-622-1000
  • Fax:
Mailing address:
  • Phone: 484-622-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: