Provider Demographics
NPI:1780687418
Name:CHANG, NAN-NING S (MD)
Entity Type:Individual
Prefix:DR
First Name:NAN-NING
Middle Name:S
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 1:268 SCHENCK AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3943
Mailing Address - Country:US
Mailing Address - Phone:718-766-9311
Mailing Address - Fax:718-233-4099
Practice Address - Street 1:5650 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1635
Practice Address - Country:US
Practice Address - Phone:718-766-9311
Practice Address - Fax:718-233-4099
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203366207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG87564Medicare UPIN
NYNC052B5710Medicare ID - Type UnspecifiedMEDICARE PROVIDER
NY07630GMedicare ID - Type UnspecifiedGHI MEDICARE