Healthcare Provider Details

I. General information

NPI: 1285774901
Provider Name (Legal Business Name): INNA IOFFE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 EAGLE ROCK AVE
ROSELAND NJ
07068-1723
US

IV. Provider business mailing address

204 EAGLE ROCK AVE
ROSELAND NJ
07068-1723
US

V. Phone/Fax

Practice location:
  • Phone: 973-226-5212
  • Fax: 973-226-5447
Mailing address:
  • Phone: 973-226-5212
  • Fax: 973-226-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA04552300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: