Provider Demographics
NPI:1275572513
Name:BOCK, KENNETH ALAN (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALAN
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 1:50 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1633
Mailing Address - Country:US
Mailing Address - Phone:845-758-0001
Mailing Address - Fax:845-758-0022
Practice Address - Street 1:50 OLD FARM RD
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1633
Practice Address - Country:US
Practice Address - Phone:845-758-0001
Practice Address - Fax:845-758-0022
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150111-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine