Healthcare Provider Details

I. General information

NPI: 1972427680
Provider Name (Legal Business Name): LILIAN CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PROSPECT AVE
MIDDLETOWN NY
10940-4133
US

IV. Provider business mailing address

227 BABBITT RD
BEDFORD HILLS NY
10507-2018
US

V. Phone/Fax

Practice location:
  • Phone: 844-868-7666
  • Fax:
Mailing address:
  • Phone: 914-843-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: