Provider Demographics
NPI:1952396228
Name:BOCHENEK, JOANNA BARBARA (MD)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:BARBARA
Last Name:BOCHENEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MIDWAY PARK DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2656
Mailing Address - Country:US
Mailing Address - Phone:845-343-0728
Mailing Address - Fax:845-343-2087
Practice Address - Street 1:400 MIDWAY PARK DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2656
Practice Address - Country:US
Practice Address - Phone:845-343-0728
Practice Address - Fax:845-343-2087
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228294208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00472931Medicaid
331832OtherMEDICARE
NY00472931Medicaid