Provider Demographics
NPI:1407018930
Name:COX, BRIAN MICHAEL (DCPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MICHAEL
Last Name:COX
Suffix:
Gender:M
Credentials:DCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-1100
Mailing Address - Country:US
Mailing Address - Phone:716-826-2766
Mailing Address - Fax:716-825-3645
Practice Address - Street 1:3720 SOUTH PARK AVE
Practice Address - Street 2:
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-1100
Practice Address - Country:US
Practice Address - Phone:716-826-2766
Practice Address - Fax:716-825-3645
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008802111N00000X
NY011513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA9966OtherMEDICARE
NYRA9967OtherMEDICARE
NYRA9966OtherMEDICARE