Provider Demographics
NPI:1366426264
Name:CHANG, PETER YOUK-TWOO (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:YOUK-TWOO
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FIELDCREST DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5439
Mailing Address - Country:US
Mailing Address - Phone:845-623-8400
Mailing Address - Fax:845-623-2451
Practice Address - Street 1:55 OLD TURNPIKE RD
Practice Address - Street 2:SUITE 605
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2461
Practice Address - Country:US
Practice Address - Phone:845-623-8400
Practice Address - Fax:845-623-2451
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171437207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01632535Medicaid
NY47K451Medicare ID - Type Unspecified
NYF22811Medicare UPIN