Provider Demographics
NPI:1881917763
Name:BOCK, CHRISTY R (RD, CDN)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:R
Last Name:BOCK
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 987
Mailing Address - Street 2:21 ORCHARD STREET
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5004
Mailing Address - Country:US
Mailing Address - Phone:845-343-7614
Mailing Address - Fax:845-343-5390
Practice Address - Street 1:21 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-5004
Practice Address - Country:US
Practice Address - Phone:845-343-7614
Practice Address - Fax:845-343-5390
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48006884133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered