Basic Information
| Provider Information | |||||||||
| NPI: | 1649280413 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | INOYATOVA | ||||||||
| FirstName: | INNA | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2269 OCEAN AVE | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112293103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183398200 | ||||||||
| FaxNumber: | 7183360069 | ||||||||
| Practice Location | |||||||||
| Address1: | 2269 OCEAN AVE | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112293103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183398200 | ||||||||
| FaxNumber: | 7183360069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 05/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 216437 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02023265 | 05 | NY | MEDICAID |