Provider Demographics
NPI:1073922704
Name:COX, PHILIP (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:COX
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5617
Mailing Address - Country:US
Mailing Address - Phone:315-624-8150
Mailing Address - Fax:315-797-1537
Practice Address - Street 1:1903 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5617
Practice Address - Country:US
Practice Address - Phone:315-624-8150
Practice Address - Fax:315-797-1537
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017244363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical