Healthcare Provider Details

I. General information

NPI: 1649795394
Provider Name (Legal Business Name): GOOD SHEPHERD PRIMARY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 02/14/2024
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 ROUTE 110
FARMINGDALE NY
11735-4820
US

IV. Provider business mailing address

1111 ROUTE 110
FARMINGDALE NY
11735-4820
US

V. Phone/Fax

Practice location:
  • Phone: 516-895-5050
  • Fax: 516-895-5088
Mailing address:
  • Phone: 516-895-5050
  • Fax: 516-895-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number267443
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HEBA A ZAHER
Title or Position: MD
Credential: MD
Phone: 516-895-5050