Provider Demographics
NPI:1679671283
Name:CHANG, JOSEPH J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
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 1:2315 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4332
Mailing Address - Country:US
Mailing Address - Phone:646-962-2110
Mailing Address - Fax:646-962-0160
Practice Address - Street 1:2315 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4332
Practice Address - Country:US
Practice Address - Phone:646-962-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02093649Medicaid
NY857451Medicare ID - Type Unspecified
NY02093649Medicaid