Provider Demographics
NPI:1902032188
Name:INOYAMA, KATHERINE S (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:S
Last Name:INOYAMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:IRENE
Other - Last Name:SLEZICKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1200 E RIDGEWOOD AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3937
Mailing Address - Country:US
Mailing Address - Phone:201-444-0868
Mailing Address - Fax:201-447-0581
Practice Address - Street 1:1200 E RIDGEWOOD AVE STE 208
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3937
Practice Address - Country:US
Practice Address - Phone:201-444-0868
Practice Address - Fax:201-447-0581
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1959532084N0400X
CAA1250372084N0400X
NJ25MA096822002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology