Provider Demographics
NPI:1437470895
Name:DR GOODNIGHT CENTER FOR EVERLASTING BEAUTY
Entity Type:Organization
Organization Name:DR GOODNIGHT CENTER FOR EVERLASTING BEAUTY
Other - Org Name:OPTIMUM VITALITY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WAYN
Authorized Official - Last Name:GOODNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-427-2711
Mailing Address - Street 1:535 HIGH MOUNTAIN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2665
Mailing Address - Country:US
Mailing Address - Phone:973-427-2711
Mailing Address - Fax:973-949-5350
Practice Address - Street 1:535 HIGH MOUNTAIN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2665
Practice Address - Country:US
Practice Address - Phone:973-427-2711
Practice Address - Fax:973-949-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06252500207YS0123X
2082S0099X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty