Provider Demographics
NPI:1124103585
Name:GOOD WILL MEDICAL PC
Entity type:Organization
Organization Name:GOOD WILL MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING HOSPITALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-734-2345
Mailing Address - Street 1:158 WEST 27TH STREET
Mailing Address - Street 2:11 FLOOR SOUTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6216
Mailing Address - Country:US
Mailing Address - Phone:212-524-7724
Mailing Address - Fax:212-543-8201
Practice Address - Street 1:51 15 BEACH CHANNEL DRIVE
Practice Address - Street 2:PENINSULA HOSPITAL
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1074
Practice Address - Country:US
Practice Address - Phone:718-734-2345
Practice Address - Fax:718-734-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207114207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01809549Medicaid
NY01809549Medicaid
G61419Medicare UPIN