Provider Demographics
NPI:1487622718
Name:CHANG, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 RIVER RD
Mailing Address - Street 2:STE 300
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-6527
Mailing Address - Country:US
Mailing Address - Phone:201-224-8831
Mailing Address - Fax:
Practice Address - Street 1:7650 RIVER RD STE 300
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-6527
Practice Address - Country:US
Practice Address - Phone:201-520-1919
Practice Address - Fax:201-453-2782
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07026900208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7586205Medicaid
NJ7586205Medicaid
NJH19519Medicare UPIN