Provider Demographics
NPI:1699756080
Name:CHANG, THOMAS TM (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:TM
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:70 E 10TH ST
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5102
Mailing Address - Country:US
Mailing Address - Phone:212-673-5650
Mailing Address - Fax:212-673-7257
Practice Address - Street 1:70 E 10TH ST
Practice Address - Street 2:SUITE 1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-5102
Practice Address - Country:US
Practice Address - Phone:212-673-5650
Practice Address - Fax:212-673-7257
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY144469207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00698137Medicaid
NY71D951Medicare PIN
NYB78984Medicare UPIN
NY71D952Medicare PIN