Provider Demographics
NPI:1154398923
Name:OURVAN, DOROTHY RENEE (DO)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:RENEE
Last Name:OURVAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:740 IRON LATCH RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1413
Mailing Address - Country:US
Mailing Address - Phone:201-677-0671
Mailing Address - Fax:201-342-0267
Practice Address - Street 1:360 ESSEX ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8550
Practice Address - Country:US
Practice Address - Phone:201-336-8686
Practice Address - Fax:201-342-3546
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine