Healthcare Provider Details

I. General information

NPI: 1295495331
Provider Name (Legal Business Name): INTEGRATIVE HYPERBARIC NOVA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19465 DEERFIELD AVE STE 308
LEESBURG VA
20176-1701
US

IV. Provider business mailing address

19465 DEERFIELD AVE STE 308
LEESBURG VA
20176-1701
US

V. Phone/Fax

Practice location:
  • Phone: 703-938-1421
  • Fax: 703-938-1424
Mailing address:
  • Phone: 571-595-2610
  • Fax: 703-938-1424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATHANIEL DAVID GOREN
Title or Position: C.O.O.
Credential:
Phone: 703-938-1421