Provider Demographics
NPI:1912488370
Name:LAMBERGMAN, JACLYN RAE
Entity type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:RAE
Last Name:LAMBERGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MOUNT KEMBLE AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5134
Mailing Address - Country:US
Mailing Address - Phone:301-785-2768
Mailing Address - Fax:
Practice Address - Street 1:41 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4038
Practice Address - Country:US
Practice Address - Phone:908-795-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08723225X00000X
NJ46TR01078300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist