Provider Demographics
NPI:1992983076
Name:CHANG SONG CHOI MD PC
Entity type:Organization
Organization Name:CHANG SONG CHOI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:SONG
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-589-6919
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-1239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46 GOODWIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-589-6919
Practice Address - Fax:860-582-2890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANG SONG CHOI MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT015857207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty