Provider Demographics
NPI:1033310644
Name:CHANG, TERESA V (PT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:V
Last Name:CHANG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4126
Mailing Address - Country:US
Mailing Address - Phone:201-968-1200
Mailing Address - Fax:201-968-1400
Practice Address - Street 1:214 STATE ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5500
Practice Address - Country:US
Practice Address - Phone:201-968-1200
Practice Address - Fax:201-968-1400
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00211600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ048238Medicare ID - Type Unspecified