Healthcare Provider Details

I. General information

NPI: 1265616908
Provider Name (Legal Business Name): CHARLIE JIJER CHANGCHIEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVERVIEW PLZ MILLENNIUM PEDIATRIC CARE, RIVERVIEW MEDICAL CENTER
RED BANK NJ
07701-1864
US

IV. Provider business mailing address

1 RIVERVIEW PLZ MILLENNIUM PEDIATRIC CARE, RIVERVIEW MEDICAL CENTER
RED BANK NJ
07701-1864
US

V. Phone/Fax

Practice location:
  • Phone: 732-450-2801
  • Fax: 732-450-2802
Mailing address:
  • Phone: 732-450-2801
  • Fax: 732-450-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08348300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: