Provider Demographics
NPI:1720334527
Name:CHS PHYSICIAN PARTNERS, PC
Entity Type:Organization
Organization Name:CHS PHYSICIAN PARTNERS, PC
Other - Org Name:BELLMORE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF MEDICAL AFFAIRS
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 1054
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1054
Mailing Address - Country:US
Mailing Address - Phone:516-629-2081
Mailing Address - Fax:516-629-2027
Practice Address - Street 1:2053 BELLMORE AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5603
Practice Address - Country:US
Practice Address - Phone:516-679-3627
Practice Address - Fax:516-679-3631
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHS PHYSICIAN PARTNERS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-30
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty