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General NPI Number Information
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NPI Number | 1649265752
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Entity Type | Individual
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Provider Name | BENJAMIN STEVEN CHACK D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 3 CORNERSTONE DRIVE SUITE 703
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City | LANGHORNE
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State | PA
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Zip | 19047
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Country | US
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Telephone | 267-689-1000
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Fax | 267-689-1008
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Provider Business Mailing Address
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Address Line | 3 CORNERSTONE DR SUITE 703
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City | LANGHORNE
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State | PA
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Zip | 19047-1320
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Country | US
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Telephone | 267-689-1000
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Fax | 267-689-1008
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | OS005703L
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License Number State | PA
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