Provider Demographics
NPI:1730997271
Name:CHANG, HOWARD (RN, BSN)
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 COPPER WOODS
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2961
Mailing Address - Country:US
Mailing Address - Phone:310-775-3323
Mailing Address - Fax:
Practice Address - Street 1:35 COPPER WOODS
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-2961
Practice Address - Country:US
Practice Address - Phone:310-775-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY811201163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse