Provider Demographics
NPI:1922169093
Name:CHANG, BERNARD PO-FU (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:PO-FU
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 1:32 HINE STREET
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503
Mailing Address - Country:US
Mailing Address - Phone:973-742-2151
Mailing Address - Fax:973-742-2195
Practice Address - Street 1:32 HINE STREET
Practice Address - Street 2:SUITE 208
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503
Practice Address - Country:US
Practice Address - Phone:973-742-2151
Practice Address - Fax:973-742-2195
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02516800207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2764709Medicaid
NJ2764709Medicaid