Provider Demographics
NPI:1649219858
Name:BOCK, STEVEN JAY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAY
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 1:187 E MARKET ST STE 169
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1727
Mailing Address - Country:US
Mailing Address - Phone:845-876-0300
Mailing Address - Fax:845-876-0388
Practice Address - Street 1:187 E MARKET ST STE 169
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1727
Practice Address - Country:US
Practice Address - Phone:845-876-0300
Practice Address - Fax:845-876-0388
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA112387-1207Q00000X
CA31913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine