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General NPI Number Information
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NPI Number | 1144592601
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Entity Type | Individual
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Provider Name | RENA MOY-CHANG O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 17 S SUMMIT ST
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City | TENAFLY
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State | NJ
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Zip | 07670-2025
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Country | US
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Telephone | 201-465-2115
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Fax |
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Provider Business Mailing Address
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Address Line | 10 LAURIE DR
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2222
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Country | US
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Telephone | 201-658-7920
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T005697
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00635200
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License Number State | NJ
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