Healthcare Provider Details

I. General information

NPI: 1215259833
Provider Name (Legal Business Name): JENNIFER M BOCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 MOUNTAINVIEW RD
TILLSON NY
12486-1228
US

IV. Provider business mailing address

154 MOUNTAINVIEW RD
TILLSON NY
12486-1228
US

V. Phone/Fax

Practice location:
  • Phone: 845-389-5775
  • Fax: 845-331-8427
Mailing address:
  • Phone: 845-389-5775
  • Fax: 845-331-8427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number616773-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: