Provider Demographics
NPI:1649265752
Name:CHACK, BENJAMIN STEVEN (DO)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:STEVEN
Last Name:CHACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CORNERSTONE DR
Mailing Address - Street 2:SUITE 703
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1320
Mailing Address - Country:US
Mailing Address - Phone:267-689-1000
Mailing Address - Fax:267-689-1008
Practice Address - Street 1:3 CORNERSTONE DRIVE
Practice Address - Street 2:SUITE 703
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:267-689-1000
Practice Address - Fax:267-689-1008
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005703L207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0062114000OtherAMERIHEALTH
PA0062114000OtherKHPE
PA232558450OtherINTERGROUP
PA109023OtherONE HEALTH PLAN
PA232558450OtherFIDELITY PMG NETWORK
PABUS004OtherOXFORD HEALTH
PA232558450OtherBSNJ
PR398969OtherMAMSI
PA57504OtherUSHC
PA487379OtherBLUE SHIELD PA
PAD87379OtherINTERCOUNTY
PR1158976002OtherCIGNA
PA487379OtherPERSONAL CHOICE
PA3Y4296OtherHEALTHNET
PA0062114000OtherAMERIHEALTH
PA232558450OtherBSNJ