Healthcare Provider Details

I. General information

NPI: 1568205540
Provider Name (Legal Business Name): ELIZABETH INAMASU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INTERNATIONAL DR STE 2
BUDD LAKE NJ
07828-1383
US

IV. Provider business mailing address

35 NETCONG HTS APT 5
NETCONG NJ
07857-1735
US

V. Phone/Fax

Practice location:
  • Phone: 833-489-2622
  • Fax:
Mailing address:
  • Phone: 732-547-1801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: