Provider Demographics
NPI:1245661933
Name:COX, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 CRESCENT ST
Mailing Address - Street 2:APT 2520
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4215
Mailing Address - Country:US
Mailing Address - Phone:631-834-2682
Mailing Address - Fax:
Practice Address - Street 1:4310 CRESCENT ST
Practice Address - Street 2:APT 2520
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4215
Practice Address - Country:US
Practice Address - Phone:631-834-2682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY845 258 986174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY102387795Medicaid