MEDICARE: GOODWILL INDUSTRIES OF GREATER NEW YORK AND NORTHERN NEW JERSEY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801080478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODWILL INDUSTRIES OF GREATER NEW YORK AND NORTHERN NEW JERSEY, INC

Provider Business Mailing Address
First Line	:	25 ELM PLACE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5355
Country	:	US
Telephone Number	:	718-246-4905
Fax Number	:	929-481-4780

Provider Business Practice Location Address
First Line	:	4502 DITMARS BOULEVARD
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11105-1363
Country	:	US
Telephone Number	:	718-371-7258
Fax Number	:	929-481-4780

Authorized Official
Title or Position	:	PRESIDENT & C.E.O.
Name	:	KATY GAUK-STIGGE
Credential	:
Telephone Number	:	718-777-6330

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	12/19/2025

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