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General NPI Number Information
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NPI Number | 1437470895
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Entity Type | Organization
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Legal Business Name | DR GOODNIGHT CENTER FOR EVERLASTING BEAUTY
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 06/18/2010
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Provider Practice Location Address
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Address Line | 535 HIGH MOUNTAIN RD SUITE 110
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City | NORTH HALEDON
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State | NJ
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Zip | 07508-2665
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Country | US
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Telephone | 973-427-2711
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Fax | 973-949-5350
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Provider Business Mailing Address
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Address Line | 535 HIGH MOUNTAIN RD SUITE 110
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City | NORTH HALEDON
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State | NJ
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Zip | 07508-2665
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Country | US
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Telephone | 973-427-2711
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Fax | 973-949-5350
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Authorized Official
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Title or Position | OWNER/EXECUTIVE DIRECTOR
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Name | DR. JAMES WAYN GOODNIGHT
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Credential | M.D.
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Telephone | 973-427-2711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 25MA06252500
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License Number State | NJ
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