MEDICARE: DR. NAN-NING S CHANG M.D.

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	207RC0000X	Cardiovascular Disease Physician	203366	NY

General Provider Information

NPI Number	:	1780687418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAN-NING S CHANG M.D.

Provider Business Mailing Address
First Line	:	268 SCHENCK AVE
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-3943
Country	:	US
Telephone Number	:	718-766-9311
Fax Number	:	718-233-4099

Provider Business Practice Location Address
First Line	:	5650 FRANCIS LEWIS BLVD
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-1635
Country	:	US
Telephone Number	:	718-766-9311
Fax Number	:	718-233-4099

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

Provider Enumeration Date	:	05/26/2005
Last Update Date	:	07/09/2007

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