Provider Demographics
NPI:1821093279
Name:MOQUIN, ROSS RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:RYAN
Last Name:MOQUIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-475-3999
Mailing Address - Fax:315-470-4014
Practice Address - Street 1:739 IRVING AVE STE 600
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1663
Practice Address - Country:US
Practice Address - Phone:315-701-2550
Practice Address - Fax:315-701-2551
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY240707207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02809254Medicaid
NY02809254Medicaid
RB1579Medicare PIN