Provider Demographics
NPI:1053718569
Name:CHANG, JASPER OLIVER (AT, ATC, CES)
Entity type:Individual
Prefix:MR
First Name:JASPER
Middle Name:OLIVER
Last Name:CHANG
Suffix:
Gender:M
Credentials:AT, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 ESTATES BLVD
Mailing Address - Street 2:APT. #13
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-2109
Mailing Address - Country:US
Mailing Address - Phone:562-895-4306
Mailing Address - Fax:
Practice Address - Street 1:CALDWELL FIELDHOUSE
Practice Address - Street 2:FACULTY ROAD
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08544-0001
Practice Address - Country:US
Practice Address - Phone:609-258-3527
Practice Address - Fax:609-258-7045
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010013662255A2300X
NJ25MT002116002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer