Provider Demographics
NPI:1689031577
Name:EIGHTH AVENUE MEDICAL, PLLC
Entity Type:Organization
Organization Name:EIGHTH AVENUE MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANGZHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-255-6391
Mailing Address - Street 1:839 57TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-6851
Mailing Address - Country:US
Mailing Address - Phone:718-255-6391
Mailing Address - Fax:718-255-6392
Practice Address - Street 1:839 57TH ST FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-6851
Practice Address - Country:US
Practice Address - Phone:718-255-6391
Practice Address - Fax:718-255-6392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty