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Individual

DR. MARK CHANG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2 MEDICAL PARK DR., WEST NYAC, NY 10994
(845) 354-5000
(845) 354-9469
Mailing address
532 BROADHOLLOW RD, SUITE 142, MELVILLE, NY 11747-3672
(516) 931-0041

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
240243-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02889150
NY
01
MC005S3071
BLUE CROSS
NY
Enumeration date
04/11/2007
Last updated
05/18/2012
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