Provider Demographics
NPI:1477549954
Name:BROCK, JAMES STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEVEN
Last Name:BROCK
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 1:655 SHREWSBURY AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4179
Mailing Address - Country:US
Mailing Address - Phone:732-747-4744
Mailing Address - Fax:732-747-4751
Practice Address - Street 1:655 SHREWSBURY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4179
Practice Address - Country:US
Practice Address - Phone:732-747-4744
Practice Address - Fax:732-747-4751
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168229208600000X, 2086S0127X, 2086S0129X
FLME62669208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02641532Medicaid
NY02641532Medicaid
3576H1Medicare ID - Type Unspecified