Provider Demographics
NPI:1083889117
Name:CHANG, ANDREW A (MD,MPH,MA)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:A
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD,MPH,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:451 CLARKSON AVE
Mailing Address - Street 2:E BUILDING, 7TH FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2054
Mailing Address - Country:US
Mailing Address - Phone:718-245-3325
Mailing Address - Fax:718-245-5587
Practice Address - Street 1:451 CLARKSON AVE
Practice Address - Street 2:E BUILDING, 7TH FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2054
Practice Address - Country:US
Practice Address - Phone:718-245-3325
Practice Address - Fax:718-245-5587
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY258231-1207R00000X
UT12715045-1205207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03491921Medicaid