Healthcare Provider Details

I. General information

NPI: 1346212081
Provider Name (Legal Business Name): FANG CHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 CANAL ST
NEW YORK NY
10013-3501
US

IV. Provider business mailing address

254 CANAL ST ROOM 5003
NEW YORK NY
10013-3501
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-6888
  • Fax: 212-966-6883
Mailing address:
  • Phone: 212-966-6888
  • Fax: 212-966-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number212269
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number212269
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: