1073516027 NPI number — DR. JOHN CHU-HONG CHANG M.D.

Table of content: DR. JOHN CHU-HONG CHANG M.D. (NPI 1073516027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073516027 NPI number — DR. JOHN CHU-HONG CHANG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANG
Provider First Name:
JOHN
Provider Middle Name:
CHU-HONG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073516027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
169 N MIDDLETOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARL RIVER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10965-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-735-5666
Provider Business Mailing Address Fax Number:
845-735-5673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
169 N MIDDLETOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARL RIVER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10965-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-735-5666
Provider Business Practice Location Address Fax Number:
845-735-5673
Provider Enumeration Date:
05/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  225687 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: 225687-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00014839 . This is a "PALMETTO GBA RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 132998987 . This is a "TAX ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02362274 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".