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General NPI Number Information
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NPI Number | 1710549779
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Entity Type | Organization
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Legal Business Name | CENTERHEALTH MEDICAL PLLC
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Dates
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Enumeration Date | 06/30/2019
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Last Update Date | 06/30/2019
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Provider Practice Location Address
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Address Line | 3808 UNION ST STE 3K
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City | FLUSHING
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State | NY
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Zip | 11354-5670
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Country | US
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Telephone | 718-578-1318
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Fax |
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Provider Business Mailing Address
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Address Line | 14000 E 980 NORTH RD
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City | GEORGETOWN
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State | IL
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Zip | 61846-7511
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Country | US
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Telephone | 718-578-1318
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | WAN TAN CHANG
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Credential | MD
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Telephone | 718-578-1318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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