Provider Demographics
NPI:1861927956
Name:CHANG, ERNEST WHANWOOK (MD PHD)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:WHANWOOK
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 LYNETTE DR
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2106
Mailing Address - Country:US
Mailing Address - Phone:617-877-8158
Mailing Address - Fax:
Practice Address - Street 1:333 OLD HOOK RD STE 200
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3200
Practice Address - Country:US
Practice Address - Phone:617-877-8158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296481207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
13-3971298OtherEIN