Healthcare Provider Details

I. General information

NPI: 1437470895
Provider Name (Legal Business Name): DR GOODNIGHT CENTER FOR EVERLASTING BEAUTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 HIGH MOUNTAIN RD SUITE 110
NORTH HALEDON NJ
07508-2665
US

IV. Provider business mailing address

535 HIGH MOUNTAIN RD SUITE 110
NORTH HALEDON NJ
07508-2665
US

V. Phone/Fax

Practice location:
  • Phone: 973-427-2711
  • Fax: 973-949-5350
Mailing address:
  • Phone: 973-427-2711
  • Fax: 973-949-5350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number25MA06252500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES WAYN GOODNIGHT
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential: M.D.
Phone: 973-427-2711