Provider Demographics
NPI:1073579124
Name:BOCK, GEORGE H (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:H
Last Name:BOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2448
Mailing Address - Country:US
Mailing Address - Phone:718-932-1000
Mailing Address - Fax:646-224-8333
Practice Address - Street 1:2510 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2448
Practice Address - Country:US
Practice Address - Phone:718-932-1000
Practice Address - Fax:646-224-8333
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185051208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01018505NYOtherANTHEM HEALTH
NY01434335Medicaid
NY185051D20OtherHEALTHFIRST
NY75H943OtherEMPIRE BLUE CROSS BLUE SHIELD
NY185051OtherHIP
NY1303200OtherFIRST HEALTH
NY0C0815OtherHEALTHNET
NY990003315OtherRR MEDICARE
NYNS2170OtherOXFORD HEALTH PLAN
NY1802534006OtherCIGNA
NY75H943OtherUNICARE
NYNS2170OtherOXFORD HEALTH PLAN
NY75H943OtherEMPIRE BLUE CROSS BLUE SHIELD
NY75H941Medicare PIN