MEDICARE: ALBERT CHANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22DI02895600	NJ

General Provider Information

NPI Number	:	1265141048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT CHANG

Provider Business Mailing Address
First Line	:	154 HAVEN AVE APT 608
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-1180
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 48TH ST
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-6439
Country	:	US
Telephone Number	:	201-866-8880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	11/21/2022

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Directions to “ ALBERT CHANG ” Practice Location

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