Active NPI
Chanak Chantachote, M.D.
- Surgical Critical Care Physician
- Northport, NY
National Provider Identifier
1093004384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Critical Care Physician
- License
- A143223
- Practice address
- Department of Surgery
79 Middleville Rd
Northport, NY 11725 - Phone
- (631) 261-4400
- NPI assigned
- Apr 7, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Critical Care Physician | 2086S0102X | A143223 | CA | Primary |
| Trauma Surgery Physician | 2086S0127X | A143223 | CA |
Addresses
Primary practice location
Department of Surgery
79 Middleville Rd
Northport, NY 11725
Mailing address
Department of Surgery
79 Middleville Rd
Northport, NY 11725
Phone (631) 261-4400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A143223 | CA | MD | Trauma Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599609600000",
"number": "1093004384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DEPARTMENT OF SURGERY",
"address_2": "79 MIDDLEVILLE RD",
"city": "NORTHPORT",
"state": "NY",
"postal_code": "11725",
"telephone_number": "631-261-4400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "DEPARTMENT OF SURGERY",
"address_2": "79 MIDDLEVILLE RD",
"city": "NORTHPORT",
"state": "NY",
"postal_code": "11725",
"telephone_number": "631-261-4400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANTACHOTE",
"first_name": "CHANAK",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-04-07",
"last_updated": "2020-09-09",
"certification_date": "2020-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0102X",
"taxonomy_group": "",
"desc": "Surgery, Surgical Critical Care",
"state": "CA",
"license": "A143223",
"primary": true
},
{
"code": "2086S0127X",
"taxonomy_group": "",
"desc": "Surgery, Trauma Surgery",
"state": "CA",
"license": "A143223",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.