Provider Demographics
NPI:1922279520
Name:CHANG, BERNARD P (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:P
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RIVERSIDE BLVD APT 16F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0422
Mailing Address - Country:US
Mailing Address - Phone:415-407-3858
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:SUITE 137
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-22
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264007-1207P00000X
MA236124207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine