Provider Demographics
NPI:1801029400
Name:CHANG, BRIAN (DACM, DAC, LAC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:DACM, DAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36-42 NEWARK ST STE 203
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5655
Mailing Address - Country:US
Mailing Address - Phone:201-754-0104
Mailing Address - Fax:
Practice Address - Street 1:36-42 NEWARK ST STE 203
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5655
Practice Address - Country:US
Practice Address - Phone:201-754-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-29
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00345171100000X
CT000486171100000X
NJ25MZ00067700171100000X
NY004061-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist