Provider Demographics
NPI:1841442357
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:SOLE PROPRIETOR
Authorized Official - Prefix:
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:516-612-7390
Mailing Address - Street 1:135 ROCKAWAY TPKE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1031
Mailing Address - Country:US
Mailing Address - Phone:516-612-7390
Mailing Address - Fax:516-612-7392
Practice Address - Street 1:80 MARCUS DR
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4230
Practice Address - Country:US
Practice Address - Phone:631-391-8366
Practice Address - Fax:631-454-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA40008890Medicare PIN