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General NPI Number Information
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NPI Number | 1154398923
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Entity Type | Individual
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Provider Name | DOROTHY RENEE OURVAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 360 ESSEX ST
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City | HACKENSACK
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State | NJ
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Zip | 07601-8550
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Country | US
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Telephone | 201-336-8686
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Fax | 201-342-3546
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Provider Business Mailing Address
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Address Line | 740 IRON LATCH RD
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City | FRANKLIN LAKES
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State | NJ
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Zip | 07417-1413
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Country | US
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Telephone | 201-677-0671
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Fax | 201-342-0267
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 46435
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License Number State | NJ
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