Healthcare Provider Details

I. General information

NPI: 1114912177
Provider Name (Legal Business Name): BUCKS ENT ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CORNERSTONE DR SUITE 703
LANGHORNE PA
19047-1320
US

IV. Provider business mailing address

3 CORNERSTONE DR SUITE 703
LANGHORNE PA
19047-1320
US

V. Phone/Fax

Practice location:
  • Phone: 267-689-1000
  • Fax: 267-689-1008
Mailing address:
  • Phone: 267-689-1000
  • Fax: 267-689-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. BENJAMIN STEVEN CHACK
Title or Position: PHYSICIAN/SURGEON
Credential: D.O.
Phone: 267-689-1000