Provider Demographics
NPI:1538222039
Name:CHANG, NGA (MD)
Entity type:Individual
Prefix:
First Name:NGA
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6236 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1125
Mailing Address - Country:US
Mailing Address - Phone:718-359-0489
Mailing Address - Fax:
Practice Address - Street 1:81 ELIZABETH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4729
Practice Address - Country:US
Practice Address - Phone:212-431-7098
Practice Address - Fax:212-431-7098
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148111208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00894211Medicaid
C67029Medicare UPIN
NY36D192Medicare PIN