1285774901 NPI number — DR. INNA IOFFE MD

Table of content: DR. INNA IOFFE MD (NPI 1285774901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285774901 NPI number — DR. INNA IOFFE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IOFFE
Provider First Name:
INNA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285774901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 EAGLE ROCK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07068-1723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-226-5212
Provider Business Mailing Address Fax Number:
973-226-5447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 EAGLE ROCK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07068-1723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-226-5212
Provider Business Practice Location Address Fax Number:
973-226-5447
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA04552300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1118613 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 505097 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 10441 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2350133 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1K3412 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1953307 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 76194497 . This is a "MULTIPLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8161909 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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