Provider Demographics
NPI:1275342313
Name:GORNY, JEFFREY ROBERT
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROBERT
Last Name:GORNY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-6908
Mailing Address - Country:US
Mailing Address - Phone:314-657-0464
Mailing Address - Fax:
Practice Address - Street 1:1812 GAWAIN CIR
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-2450
Practice Address - Country:US
Practice Address - Phone:937-260-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications