Provider Demographics
NPI:1245340207
Name:GOOD WILL MEDICAL, P.C.
Entity type:Organization
Organization Name:GOOD WILL MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-563-2497
Mailing Address - Street 1:158 W 27TH ST
Mailing Address - Street 2:11TH FLOOR SOUTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6216
Mailing Address - Country:US
Mailing Address - Phone:212-563-2497
Mailing Address - Fax:212-563-0605
Practice Address - Street 1:5115 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1042
Practice Address - Country:US
Practice Address - Phone:212-563-2497
Practice Address - Fax:212-563-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02167279Medicaid
NYG100000188 (QUEENS)Medicare PIN