Healthcare Provider Details

I. General information

NPI: 1073516027
Provider Name (Legal Business Name): JOHN CHU-HONG CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 N MIDDLETOWN RD
PEARL RIVER NY
10965-2029
US

IV. Provider business mailing address

169 N MIDDLETOWN RD
PEARL RIVER NY
10965-2029
US

V. Phone/Fax

Practice location:
  • Phone: 845-735-5666
  • Fax: 845-735-5673
Mailing address:
  • Phone: 845-735-5666
  • Fax: 845-735-5673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number225687
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number225687-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: