Healthcare Provider Details

I. General information

NPI: 1801590260
Provider Name (Legal Business Name): CHANGLIN GONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JACOBI MEDICAL CENTER, 1400 PELHAM PARKWAY SOUTH
BRONX NY
10461
US

IV. Provider business mailing address

JACOBI MEDICAL CENTER, 1400 PELHAM PARKWAY SOUTH
BRONX NY
10461
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number62180
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: