Healthcare Provider Details

I. General information

NPI: 1881892883
Provider Name (Legal Business Name): GREGORY CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

660 FIRST AVENUE, 3RD FLOOR DEPARTMENT OF RADIOLOGY, NYU LANGONE MEDICAL CENTER
NEW YORK NY
10016-3295
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-0288
  • Fax:
Mailing address:
  • Phone: 212-263-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberPENDING
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: