Healthcare Provider Details

I. General information

NPI: 1477840072
Provider Name (Legal Business Name): FELICIA BOCK DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 WYOMING AVE
WEST PITTSTON PA
18643-2741
US

IV. Provider business mailing address

810 WYOMING AVE
WEST PITTSTON PA
18643-2741
US

V. Phone/Fax

Practice location:
  • Phone: 570-654-4371
  • Fax: 570-654-0455
Mailing address:
  • Phone: 570-654-4371
  • Fax: 570-654-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006276
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: