Provider Demographics
NPI:1477069284
Name:CHANG, CHRISTINE JINGWEN (APRN, NP-C, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:JINGWEN
Last Name:CHANG
Suffix:
Gender:
Credentials:APRN, NP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 FRICK ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4135
Mailing Address - Country:US
Mailing Address - Phone:917-355-6554
Mailing Address - Fax:
Practice Address - Street 1:545 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6401
Practice Address - Country:US
Practice Address - Phone:212-263-6696
Practice Address - Fax:646-754-7057
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-17
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF10170968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF342446-1OtherFNP LICENSE
NY14202227OtherCAQH
NY14202227OtherCAQH