Healthcare Provider Details

I. General information

NPI: 1649265752
Provider Name (Legal Business Name): BENJAMIN STEVEN CHACK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CORNERSTONE DRIVE SUITE 703
LANGHORNE PA
19047
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 NumberOS005703L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: