=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750878732
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYAN MATTHEW COX MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2018
-----------------------------------------------------
Last Update Date | 08/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6620 FLY RD STE 200
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-4282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-464-4472
-----------------------------------------------------
Fax | 315-464-5222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6620 FLY RD STE 200
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-4282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-464-5551
-----------------------------------------------------
Fax | 315-464-5229
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | STUDENT
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 329612
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------