Provider Demographics
NPI:1831297183
Name:CNY FACIAL SURGERY GROUP, PC
Entity Type:Organization
Organization Name:CNY FACIAL SURGERY GROUP, PC
Other - Org Name:DOUGLAS W. HALLIDAY, M.D., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRIGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-471-8404
Mailing Address - Street 1:4939 BRITTONFIELD PARKWAY
Mailing Address - Street 2:BLDG B, SUITE 210
Mailing Address - City:E. SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:315-471-8404
Mailing Address - Fax:315-471-6803
Practice Address - Street 1:4939 BRITTONFIELD PARKWAY
Practice Address - Street 2:BLDG B, SUITE 210
Practice Address - City:E. SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-471-8404
Practice Address - Fax:315-471-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03597968Medicaid
NYDG4140Medicare PIN
NYAA0360Medicare PIN