Provider Demographics
NPI:1861616484
Name:GOREN, LAWRENCE JAY (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JAY
Last Name:GOREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX D
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-0166
Mailing Address - Country:US
Mailing Address - Phone:610-837-4683
Mailing Address - Fax:610-837-4975
Practice Address - Street 1:4607 OAKWOOD LN
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8535
Practice Address - Country:US
Practice Address - Phone:610-837-4683
Practice Address - Fax:610-837-4975
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024453E2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine