Healthcare Provider Details

I. General information

NPI: 1619315975
Provider Name (Legal Business Name): CHS PHYSICIAN PARTNERS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 MERRICK AVE
MERRICK NY
11566-1628
US

IV. Provider business mailing address

PO BOX 95000-6625
PHILADELPHIA PA
19195-6625
US

V. Phone/Fax

Practice location:
  • Phone: 516-378-3311
  • Fax: 516-546-1517
Mailing address:
  • Phone: 631-465-6297
  • Fax: 631-465-6524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JACK SOTERAKIS
Title or Position: PRESIDENT
Credential: MD
Phone: 516-562-6231