Healthcare Provider Details

I. General information

NPI: 1083309793
Provider Name (Legal Business Name): ALICE CHANG, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 04/13/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ROUTE 73 N SUITE 104
MARLTON NJ
08053
US

IV. Provider business mailing address

970 HADDON AVE UNIT 8774
COLLINGSWOOD NJ
08108-8038
US

V. Phone/Fax

Practice location:
  • Phone: 609-200-0211
  • Fax:
Mailing address:
  • Phone: 609-200-0211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALICE CHANG
Title or Position: OWNER
Credential: MD
Phone: 609-200-0211