Provider Demographics
NPI:1154605293
Name:EFFIE C. CHANG, M.D., P.C.
Entity type:Organization
Organization Name:EFFIE C. CHANG, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EFFIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:203-776-5360
Mailing Address - Street 1:136 SHERMAN AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5238
Mailing Address - Country:US
Mailing Address - Phone:203-776-5360
Mailing Address - Fax:203-787-4990
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5238
Practice Address - Country:US
Practice Address - Phone:203-776-5360
Practice Address - Fax:203-787-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17026207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB38191Medicare UPIN
CT160000529Medicare PIN
CT0468300001Medicare NSC