Healthcare Provider Details

I. General information

NPI: 1851617377
Provider Name (Legal Business Name): BENJAMIN N YOCKEY BOCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5704 BROWNSVILLE RD
PITTSBURGH PA
15236
US

IV. Provider business mailing address

5704 BROWNSVILLE RD
PITTSBURGH PA
15236-3504
US

V. Phone/Fax

Practice location:
  • Phone: 412-943-1950
  • Fax: 412-943-1954
Mailing address:
  • Phone: 412-943-1950
  • Fax: 412-943-1954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC49844
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: