Provider Demographics
NPI:1790148880
Name:BOKOVA, VALERIYA (PA-C)
Entity Type:Individual
Prefix:
First Name:VALERIYA
Middle Name:
Last Name:BOKOVA
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 1:1526 215TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1224
Mailing Address - Country:US
Mailing Address - Phone:347-406-2939
Mailing Address - Fax:
Practice Address - Street 1:1526 215TH ST FL 1
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1224
Practice Address - Country:US
Practice Address - Phone:347-406-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019535-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant