Provider Demographics
NPI:1588684427
Name:GANG, MARK JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAY
Last Name:GANG
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:2228 BLACK ROCK TPKE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3237
Mailing Address - Country:US
Mailing Address - Phone:203-336-4264
Mailing Address - Fax:203-336-4265
Practice Address - Street 1:2228 BLACK ROCK TPKE
Practice Address - Street 2:SUITE 310
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3237
Practice Address - Country:US
Practice Address - Phone:203-336-4264
Practice Address - Fax:203-336-4265
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT562103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT173505OtherMANAGED HEALTH NETWORK
CT6129154OtherUNITED HEALTHCARE
CTZS555OtherOXFORD
CT060000562CT04OtherBLUE CROSS