Provider Demographics
NPI:1306804190
Name:HALLIGAN, SEAN B (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:B
Last Name:HALLIGAN
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 1:145 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2715
Mailing Address - Country:US
Mailing Address - Phone:585-469-4880
Mailing Address - Fax:585-336-4845
Practice Address - Street 1:145 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2715
Practice Address - Country:US
Practice Address - Phone:585-469-4880
Practice Address - Fax:585-336-4845
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355266Medicaid
NY00355266Medicaid
NYRA8074Medicare ID - Type Unspecified