Provider Demographics
NPI:1902095086
Name:SAMUEL S. BADALIAN MD PC
Entity type:Organization
Organization Name:SAMUEL S. BADALIAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-472-6935
Mailing Address - Street 1:104 UNION AVE
Mailing Address - Street 2:SUITE 803
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-0000
Mailing Address - Country:US
Mailing Address - Phone:315-472-6935
Mailing Address - Fax:315-472-6936
Practice Address - Street 1:104 UNION AVE
Practice Address - Street 2:SUITE 803
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-0000
Practice Address - Country:US
Practice Address - Phone:315-472-6935
Practice Address - Fax:315-472-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211964207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01923284Medicaid
NYBA0712Medicare PIN
NYBA0711Medicare PIN