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Individual

DR. EDWIN M CHANG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1099 TARGEE ST, STATEN ISLAND, NY 10304-4310
(718) 448-3210
(718) 815-3379
Mailing address
2535 ARTHUR KILL RD, STATEN ISLAND, NY 10309-1207
(718) 448-3210
(718) 967-6023

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
1752211
NY
207T00000X
Neurological Surgery Physician
MA52820
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01512041
NY
01
130016692
RAILROAD MEDICARE
NY
Enumeration date
11/11/2005
Last updated
06/24/2011
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