Basic Information
Provider Information
NPI: 1003299629
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOREN
FirstName: ODED
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 N ACADEMY AVE
Address2:  
City: DANVILLE
State: PA
PostalCode: 178224903
CountryCode: US
TelephoneNumber: 5702716144
FaxNumber:  
Practice Location
Address1: 100 N ACADEMY AVE
Address2:  
City: DANVILLE
State: PA
PostalCode: 178225789
CountryCode: US
TelephoneNumber: 5702716144
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/30/2015
LastUpdateDate: 08/31/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/31/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207T00000XMD461955PAY Allopathic & Osteopathic PhysiciansNeurological Surgery 
207T00000X60527113WAN Allopathic & Osteopathic PhysiciansNeurological Surgery 

No ID Information.


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