Provider Demographics
NPI:1942263553
Name:CHIANG, FANG-CHIN (DO)
Entity Type:Individual
Prefix:
First Name:FANG-CHIN
Middle Name:
Last Name:CHIANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3345
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-9345
Mailing Address - Country:US
Mailing Address - Phone:201-261-0255
Mailing Address - Fax:201-845-8455
Practice Address - Street 1:769 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-3030
Practice Address - Country:US
Practice Address - Phone:201-261-0255
Practice Address - Fax:201-845-8455
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06764100207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8144401Medicaid
G62722Medicare UPIN
NJ8144401Medicaid