Provider Demographics
NPI:1073266904
Name:GOODLIFE, DAVID NEELAND (LPN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NEELAND
Last Name:GOODLIFE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4204
Mailing Address - Country:US
Mailing Address - Phone:845-331-3265
Mailing Address - Fax:
Practice Address - Street 1:15 FORTUNE RD W
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-1625
Practice Address - Country:US
Practice Address - Phone:888-750-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113075-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse