Individual
ELLEN CHANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1601 3RD AVE APT 20B, NEW YORK, NY 10128-3456
(917) 747-0011
Mailing address
1601 3RD AVE APT 20B, NEW YORK, NY 10128-3456
(917) 747-0011
Taxonomy
Speciality
Code
Description
License number
State
374K00000X
Religious Nonmedical Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
12/06/2018
Last updated
12/06/2018
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