Provider Demographics
NPI:1144592601
Name:MOY-CHANG, RENA (OD)
Entity Type:Individual
Prefix:DR
First Name:RENA
Middle Name:
Last Name:MOY-CHANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LAURIE DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2222
Mailing Address - Country:US
Mailing Address - Phone:201-658-7920
Mailing Address - Fax:
Practice Address - Street 1:17 S SUMMIT ST
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2025
Practice Address - Country:US
Practice Address - Phone:201-465-2115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005697152W00000X
NJ27OA00635200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ306392Medicare PIN