Basic Information
Provider Information
NPI: 1811192099
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COX
FirstName: BRETT
MiddleName: WAYNE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 633 3RD AVE
Address2: BOX 3
City: NEW YORK
State: NY
PostalCode: 100176706
CountryCode: US
TelephoneNumber: 6462273813
FaxNumber:  
Practice Location
Address1: 1275 YORK AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100656007
CountryCode: US
TelephoneNumber: 6462273813
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/18/2007
LastUpdateDate: 04/12/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001XA83877CAN Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
2085R0001X245000NYY Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

No ID Information.


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