Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MA02304400 | NJ |
N | 208D00000X | General Practice Physician | 25MA02304400 | NJ |
NPI | 1003181488 |
---|---|
Provider Name | Dr. Peter Chang |
First Address | Branchburg, NJ 08853-4217 |
Second Address | Branchburg, NJ 08853-4217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2012 |
Last Update Date | 18/03/2012 |