Provider Demographics
NPI:1366559056
Name:DR. CHANG AND LEBITA
Entity type:Organization
Organization Name:DR. CHANG AND LEBITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKAMBINI
Authorized Official - Middle Name:D
Authorized Official - Last Name:RECLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-494-4327
Mailing Address - Street 1:2621 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-2115
Mailing Address - Country:US
Mailing Address - Phone:610-494-4327
Mailing Address - Fax:610-494-7350
Practice Address - Street 1:2621 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-2115
Practice Address - Country:US
Practice Address - Phone:610-494-4327
Practice Address - Fax:610-494-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027429E207Q00000X
PAMD028599E207Q00000X
PAMD059221L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2237952002OtherKEYSTONE HEALTH PLAN EAST
PA445401Medicare ID - Type UnspecifiedDR. FUZEN CHANG