Provider Demographics
NPI:1649299686
Name:CHANG, CHARISSA Y (MD)
Entity type:Individual
Prefix:DR
First Name:CHARISSA
Middle Name:Y
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX 1104
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:212-987-3100
Mailing Address - Fax:212-731-5210
Practice Address - Street 1:5 EAST 98TH STREET
Practice Address - Street 2:MOUNT SINAI HOSPITAL LIVER DISEASES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-0034
Practice Address - Fax:212-289-7738
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2019-09-27
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Provider Licenses
StateLicense IDTaxonomies
NY236171207RG0100X, 204F00000X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02758318Medicaid
NY5R00924801Medicare PIN