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General NPI Number Information
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NPI Number | 1164780987
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Entity Type | Organization
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Legal Business Name | KA BOCK MD PLLC
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 11/02/2012
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Provider Practice Location Address
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Address Line | 50 OLD FARM RD
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City | RED HOOK
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State | NY
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Zip | 12571-1633
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Country | US
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Telephone | 845-758-0001
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Fax | 845-758-0022
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Provider Business Mailing Address
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Address Line | 50 OLD FARM RD
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City | RED HOOK
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State | NY
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Zip | 12571-1633
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Country | US
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Telephone | 845-758-0001
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Fax | 845-758-0022
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH A BOCK
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Credential | M.D.
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Telephone | 845-158-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 150111-1
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License Number State | NY
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