Provider Demographics
NPI:1679505424
Name:BOCK, DAVID ANDREW (DO DOCTOR OF OSTEOPA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:BOCK
Suffix:
Gender:M
Credentials:DO DOCTOR OF OSTEOPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08525-1895
Mailing Address - Country:US
Mailing Address - Phone:609-773-0940
Mailing Address - Fax:609-466-1482
Practice Address - Street 1:84 E BROAD ST
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08525-1844
Practice Address - Country:US
Practice Address - Phone:609-466-1101
Practice Address - Fax:609-466-1482
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07279400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H74452Medicare UPIN
NJ064583V6MMedicare PIN