Provider Demographics
NPI:1891766622
Name:JOFFE, IAN (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:JOFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 LAUREL OAK RD
Mailing Address - Street 2:SUITE #165
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4312
Mailing Address - Country:US
Mailing Address - Phone:856-424-3600
Mailing Address - Fax:856-424-7154
Practice Address - Street 1:1105 LAUREL OAK RD
Practice Address - Street 2:SUITE #165
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4312
Practice Address - Country:US
Practice Address - Phone:856-424-3600
Practice Address - Fax:856-424-7154
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06712400207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7771606Medicaid
NJ7771606Medicaid
NJ010562Medicare PIN