Provider Demographics
NPI:1225416837
Name:GOOD NEIGHBOR FAMILY PRACTICE AND GERIATRICS, P.C.
Entity Type:Organization
Organization Name:GOOD NEIGHBOR FAMILY PRACTICE AND GERIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YI
Authorized Official - Middle Name:
Authorized Official - Last Name:NGAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-359-8829
Mailing Address - Street 1:13338 41ST RD STE CO-3
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3782
Mailing Address - Country:US
Mailing Address - Phone:718-359-8829
Mailing Address - Fax:718-359-8827
Practice Address - Street 1:13338 41ST RD STE CO-3
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3782
Practice Address - Country:US
Practice Address - Phone:718-359-8829
Practice Address - Fax:718-359-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225366207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03582652Medicaid
NY02592450Medicaid
06523Medicare PIN
NY02592450Medicaid
NY03582652Medicaid