Provider Demographics
NPI:1588828115
Name:BOCKOFF, OLIVIA B (PA-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:B
Last Name:BOCKOFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 COOKMAN AVE APT B
Mailing Address - Street 2:
Mailing Address - City:OCEAN GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07756-1106
Mailing Address - Country:US
Mailing Address - Phone:310-927-7476
Mailing Address - Fax:
Practice Address - Street 1:1 ROBERT WOOD JOHNSON PL
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1928
Practice Address - Country:US
Practice Address - Phone:310-927-7476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-13
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00199300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ174891UA1Medicare PIN