Provider Demographics
NPI:1699890673
Name:GOOD SHEPHERD SERVICES
Entity type:Organization
Organization Name:GOOD SHEPHERD SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER & CFO
Authorized Official - Prefix:MISS
Authorized Official - First Name:GREGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-243-7070
Mailing Address - Street 1:305 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6008
Mailing Address - Country:US
Mailing Address - Phone:212-243-7070
Mailing Address - Fax:212-620-5612
Practice Address - Street 1:305 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6008
Practice Address - Country:US
Practice Address - Phone:212-243-7070
Practice Address - Fax:212-620-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00327817Medicaid