Provider Demographics
NPI:1366425530
Name:CHANGLAI, BRIAN YISHING (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:YISHING
Last Name:CHANGLAI
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 1:4921 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1307
Mailing Address - Country:US
Mailing Address - Phone:315-637-5986
Mailing Address - Fax:315-632-4426
Practice Address - Street 1:4921 BRIARWOOD LN
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-1307
Practice Address - Country:US
Practice Address - Phone:315-637-5986
Practice Address - Fax:315-632-4426
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147291207R00000X, 207RC0000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00922303Medicaid
B82601Medicare UPIN
NYRB2354Medicare PIN
NY00922303Medicaid
NYRB8442Medicare PIN
NYP00369285Medicare PIN