Provider Demographics
NPI:1376889386
Name:CHS PHYSICIAN PARTNERS, PC
Entity Type:Organization
Organization Name:CHS PHYSICIAN PARTNERS, PC
Other - Org Name:WOODMERE MEDICAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTERAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-562-6231
Mailing Address - Street 1:PO BOX 95000-6625
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-6625
Mailing Address - Country:US
Mailing Address - Phone:631-465-6297
Mailing Address - Fax:631-465-6524
Practice Address - Street 1:923 BROADWAY
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1739
Practice Address - Country:US
Practice Address - Phone:516-218-2163
Practice Address - Fax:516-218-2165
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHS PHYSICIAN PARTNERS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155661207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty