Provider Demographics
NPI:1427279694
Name:CHANG, DODY (LAC)
Entity type:Individual
Prefix:MS
First Name:DODY
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BRADLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607
Mailing Address - Country:US
Mailing Address - Phone:914-882-4151
Mailing Address - Fax:
Practice Address - Street 1:ONE BRIDGE STREET
Practice Address - Street 2:SUITE 22
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533
Practice Address - Country:US
Practice Address - Phone:914-882-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2039171100000X
CT218171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist