MEDICARE: KATHERINE S INOYAMA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	MT195953	PA
2	2084N0400X	Neurology Physician	A125037	CA
3	2084N0400X	Neurology Physician	25MA09682200	NJ

General Provider Information

NPI Number	:	1902032188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE S INOYAMA MD

Provider Business Mailing Address
First Line	:	1200 E RIDGEWOOD AVE STE 208
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3937
Country	:	US
Telephone Number	:	201-444-0868
Fax Number	:	201-447-0581

Provider Business Practice Location Address
First Line	:	1200 E RIDGEWOOD AVE STE 208
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3937
Country	:	US
Telephone Number	:	201-444-0868
Fax Number	:	201-447-0581

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	07/18/2022

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