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General NPI Number Information
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NPI Number | 1982728143
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Entity Type | Organization
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Legal Business Name | MANHATTAN RENAL ASSOCIATE, P.C.
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 80 5TH AVE # 1605
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City | NEW YORK
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State | NY
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Zip | 10011-8002
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Country | US
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Telephone | 646-543-6396
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Fax | 212-647-1931
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Provider Business Mailing Address
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Address Line | 45 RIVER DR S # 3209
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City | JERSEY CITY
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State | NJ
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Zip | 07310-3741
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Country | US
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Telephone | 646-543-6396
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Fax | 212-977-2402
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL P CHANG
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Credential | MD
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Telephone | 646-543-6396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 216277
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License Number State | NY
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