Basic Information
| Provider Information | |||||||||
| NPI: | 1861747099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAN | ||||||||
| FirstName: | ORON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64 NEW YORK AVE NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200023320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026982431 | ||||||||
| FaxNumber: | 2026982466 | ||||||||
| Practice Location | |||||||||
| Address1: | 64 NEW YORK AVE NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200023320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026982431 | ||||||||
| FaxNumber: | 2026982466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2012 | ||||||||
| LastUpdateDate: | 07/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY1000687 | DC | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.