Provider Demographics
NPI:1891861134
Name:CHANG, PETER Y (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:Y
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 1:877 STEWART AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4803
Mailing Address - Country:US
Mailing Address - Phone:516-745-6900
Mailing Address - Fax:516-745-6767
Practice Address - Street 1:877 STEWART AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4803
Practice Address - Country:US
Practice Address - Phone:516-745-6900
Practice Address - Fax:516-745-6767
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1213892086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08A501Medicare ID - Type Unspecified
NYC05257Medicare UPIN