Healthcare Provider Details

I. General information

NPI: 1902032188
Provider Name (Legal Business Name): KATHERINE S INOYAMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE IRENE SLEZICKI MD

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E RIDGEWOOD AVE STE 208
RIDGEWOOD NJ
07450-3937
US

IV. Provider business mailing address

1200 E RIDGEWOOD AVE STE 208
RIDGEWOOD NJ
07450-3937
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-0868
  • Fax: 201-447-0581
Mailing address:
  • Phone: 201-444-0868
  • Fax: 201-447-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMT195953
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA125037
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA09682200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: