Provider Demographics
NPI:1316902026
Name:CHANG, JERRY SHENG-CHIEH (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:SHENG-CHIEH
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:101 SAINT ANDREWS LN
Mailing Address - Street 2:NORTH SHORE LIJ GLEN COVE HOSPITAL, DEPT OF RADIOLOGY
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2254
Mailing Address - Country:US
Mailing Address - Phone:516-674-7540
Mailing Address - Fax:516-674-7546
Practice Address - Street 1:101 SAINT ANDREWS LN
Practice Address - Street 2:NORTH SHORE LIJ GLEN COVE HOSPITAL, DEPT OF RADIOLOGY
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2254
Practice Address - Country:US
Practice Address - Phone:516-674-7540
Practice Address - Fax:516-674-7546
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2276512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0065064Medicaid
NJ086809THMMedicare PIN
I00600Medicare UPIN