1801080478 NPI number — GOODWILL INDUSTRIES OF GREATER NEW YORK AND NORTHERN NEW JERSEY, INC

Table of content: (NPI 1801080478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801080478 NPI number — GOODWILL INDUSTRIES OF GREATER NEW YORK AND NORTHERN NEW JERSEY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOODWILL INDUSTRIES OF GREATER NEW YORK AND NORTHERN NEW JERSEY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801080478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 ELM PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11201-5355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-246-4905
Provider Business Mailing Address Fax Number:
929-481-4780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4502 DITMARS BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11105-1363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-371-7258
Provider Business Practice Location Address Fax Number:
929-481-4780
Provider Enumeration Date:
08/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GAUK-STIGGE
Authorized Official First Name:
KATY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & C.E.O.
Authorized Official Telephone Number:
718-777-6330

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02699214 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01467385 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02591651 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02195119 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02997340 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02216975 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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