Provider Demographics
NPI:1992366769
Name:CHANG, KAREN O
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:O
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-2406
Mailing Address - Country:US
Mailing Address - Phone:973-723-3490
Mailing Address - Fax:
Practice Address - Street 1:492 SPRINGFIELD AVE STE A
Practice Address - Street 2:ADDRESS 2
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-0792
Practice Address - Country:US
Practice Address - Phone:908-665-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00031600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist