Provider Demographics
NPI:1649795394
Name:GOOD SHEPHERD PRIMARY CARE PC
Entity type:Organization
Organization Name:GOOD SHEPHERD PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HEBA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-895-5050
Mailing Address - Street 1:1111 ROUTE 110
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4820
Mailing Address - Country:US
Mailing Address - Phone:516-895-5050
Mailing Address - Fax:516-895-5088
Practice Address - Street 1:1111 ROUTE 110
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4820
Practice Address - Country:US
Practice Address - Phone:516-895-5050
Practice Address - Fax:516-895-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
NY267443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty