Provider Demographics
NPI:1669455838
Name:BRIAN Y CHANGLAI MD PC
Entity Type:Organization
Organization Name:BRIAN Y CHANGLAI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:YISHING
Authorized Official - Last Name:CHANGLAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-492-5769
Mailing Address - Street 1:4921 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1307
Mailing Address - Country:US
Mailing Address - Phone:315-637-5986
Mailing Address - Fax:315-492-5855
Practice Address - Street 1:4921 BRIARWOOD LN
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-1307
Practice Address - Country:US
Practice Address - Phone:315-637-5986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147291207R00000X, 207RC0000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B82601Medicare UPIN