Provider Demographics
NPI:1154401883
Name:CHANG, BENJAMIN MINSOO (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MINSOO
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MIN
Other - Middle Name:S
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4037 81ST ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1393
Mailing Address - Country:US
Mailing Address - Phone:718-651-8414
Mailing Address - Fax:
Practice Address - Street 1:4037 81ST ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1393
Practice Address - Country:US
Practice Address - Phone:718-651-8414
Practice Address - Fax:718-651-8414
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241442208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG84371Medicare UPIN