Individual
CHANAK CHANTACHOTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
DEPARTMENT OF SURGERY, 79 MIDDLEVILLE RD, NORTHPORT, NY 11725
(631) 261-4400
Mailing address
DEPARTMENT OF SURGERY, 79 MIDDLEVILLE RD, NORTHPORT, NY 11725
(631) 261-4400
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
A143223
CA
2086S0127X
Trauma Surgery Physician
A143223
CA
Other
Enumeration date
04/07/2011
Last updated
09/09/2020
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