Provider Demographics
NPI:1821198565
Name:HANIG, CARL J (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:J
Last Name:HANIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 JAMES ST
Mailing Address - Street 2:STE 108
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2087
Mailing Address - Country:US
Mailing Address - Phone:315-472-4467
Mailing Address - Fax:315-472-0197
Practice Address - Street 1:716 JAMES ST
Practice Address - Street 2:STE 108
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2087
Practice Address - Country:US
Practice Address - Phone:315-472-4467
Practice Address - Fax:315-472-0197
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY149126-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1295723534OtherGROUP PRACTICE NPI