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NPI Code Detail

MEDICARE: BRYAN BOCCO APN

MEDICARE: BRYAN BOCCO APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner26NJ00471600NJ

General Provider Information

NPI Number : 1154750990
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYAN BOCCO APN
Provider Business Mailing Address
First Line : 47 STARLITE DR
Second Line :
City : CLARK
State : NJ
Zip : 07066-2926
Country : US
Telephone Number : 732-259-2593
Fax Number :
Provider Business Practice Location Address
First Line : 2440 HAMBURG TPKE
Second Line :
City : WAYNE
State : NJ
Zip : 07470-6226
Country : US
Telephone Number : 973-839-3400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2013
Last Update Date : 12/31/2025

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