Provider Demographics
NPI:1285774901
Name:IOFFE, INNA (MD)
Entity type:Individual
Prefix:DR
First Name:INNA
Middle Name:
Last Name:IOFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1723
Mailing Address - Country:US
Mailing Address - Phone:973-226-5212
Mailing Address - Fax:973-226-5447
Practice Address - Street 1:204 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1723
Practice Address - Country:US
Practice Address - Phone:973-226-5212
Practice Address - Fax:973-226-5447
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04552300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1118613OtherHORIZON NJ HEALTH
NJ505097OtherAETNA
NJ10441OtherUNITED HEALTHCARE
NJP2350133OtherOXFORD
NJ1K3412OtherHEALTHNET
NJ1953307OtherCIGNA
NJ76194497OtherMULTIPLAN
NJ8161909Medicaid