MEDICARE: CHS PHYSICIAN PARTNERS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician
2	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1619210713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHS PHYSICIAN PARTNERS, PC

Provider Business Mailing Address
First Line	:	PO BOX 95000-6625
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19195-6625
Country	:	US
Telephone Number	:	631-465-6297
Fax Number	:	631-465-6524

Provider Business Practice Location Address
First Line	:	400 GARDEN CITY PLZ
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-3322
Country	:	US
Telephone Number	:	516-742-5700
Fax Number	:	516-742-5701

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACK SOTERAKIS
Credential	:	MD
Telephone Number	:	516-562-6231

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	07/19/2019

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