Provider Demographics
NPI:1902983471
Name:WOROCH, BOHDAR (MD)
Entity Type:Individual
Prefix:DR
First Name:BOHDAR
Middle Name:
Last Name:WOROCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 E NORTHFIELD RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4802
Mailing Address - Country:US
Mailing Address - Phone:973-597-0902
Mailing Address - Fax:973-736-9588
Practice Address - Street 1:117 VOSE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2012
Practice Address - Country:US
Practice Address - Phone:973-762-3944
Practice Address - Fax:973-736-9588
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA031497174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD18856Medicare UPIN