Provider Demographics
NPI:1417978719
Name:CHANG, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
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 1:195 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1626
Mailing Address - Country:US
Mailing Address - Phone:201-261-0255
Mailing Address - Fax:201-857-3638
Practice Address - Street 1:769 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-3030
Practice Address - Country:US
Practice Address - Phone:201-986-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA58239207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2025817OtherAETNA
NJ7280904Medicaid
NJ5100333OtherGHI
NJP997430OtherOXFORD
NJ8072916003OtherCIGNA
NJ48125OtherAMERICHOICE
NJEXP1K7136OtherHEALTH NET
NJ2025817OtherAETNA
NJ7280904Medicaid