Provider Demographics
NPI:1689882540
Name:GOREN, ISAAC (AP)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:
Last Name:GOREN
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4416
Mailing Address - Country:US
Mailing Address - Phone:954-454-5559
Mailing Address - Fax:
Practice Address - Street 1:1130 E HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4416
Practice Address - Country:US
Practice Address - Phone:954-454-5559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP927171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL200687548OtherTAX IDENIFICATION NUMBER
FLC0320OtherBCBS PROVIDER NUMBER