Provider Demographics
NPI:1235201666
Name:CHANG, HWANG NAM (MD)
Entity Type:Individual
Prefix:MR
First Name:HWANG NAM
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 EAST UNION STREET SUITE 202
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513
Mailing Address - Country:US
Mailing Address - Phone:315-331-4422
Mailing Address - Fax:315-331-9584
Practice Address - Street 1:165 EAST UNION ST SUITE 202
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513
Practice Address - Country:US
Practice Address - Phone:315-331-4422
Practice Address - Fax:315-331-9584
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121387207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00452713Medicaid
NY00452713Medicaid
NY10292BMedicare ID - Type Unspecified