Healthcare Provider Details

I. General information

NPI: 1952978678
Provider Name (Legal Business Name): JOHN DANIEL BOCINSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N WICKHAM RD STE 108
MELBOURNE FL
32935-8663
US

IV. Provider business mailing address

240 N WICKHAM RD STE 108
MELBOURNE FL
32935-8663
US

V. Phone/Fax

Practice location:
  • Phone: 321-541-1777
  • Fax: 321-541-1788
Mailing address:
  • Phone: 321-541-1777
  • Fax: 321-541-1788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021021435
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME168464
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: