Provider Demographics
NPI:1659502425
Name:CHS PHYSICIAN PARTNERS, PC
Entity Type:Organization
Organization Name:CHS PHYSICIAN PARTNERS, PC
Other - Org Name:SOUTH BAY CARDIOVASCULAR ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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:
Mailing Address - Fax:
Practice Address - Street 1:540 UNION BLVD
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:631-669-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHS PHYSICIAN PARTNERS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-28
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107338207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000900Medicare PIN