Provider Demographics
NPI:1801080478
Name:GOODWILL INDUSTRIES OF GREATER NEW YORK AND NORTHERN NEW JERSEY, INC
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF GREATER NEW YORK AND NORTHERN NEW JERSEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUK-STIGGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-777-6330
Mailing Address - Street 1:25 ELM PLACE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5355
Mailing Address - Country:US
Mailing Address - Phone:718-246-4905
Mailing Address - Fax:929-481-4780
Practice Address - Street 1:4502 DITMARS BOULEVARD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1363
Practice Address - Country:US
Practice Address - Phone:718-371-7258
Practice Address - Fax:929-481-4780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02699214Medicaid
NY01467385Medicaid
NY02591651Medicaid
NY02195119Medicaid
NY02997340Medicaid
NY02216975Medicaid