Healthcare Provider Details

I. General information

NPI: 1720141526
Provider Name (Legal Business Name): ANTHONY GERARD INFANTINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 FRANKLIN AVE
HARTFORD CT
06114-2517
US

IV. Provider business mailing address

22 MICHAEL WAY
PATTERSON NY
12563-2939
US

V. Phone/Fax

Practice location:
  • Phone: 860-947-0322
  • Fax: 860-947-0324
Mailing address:
  • Phone: 845-878-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number041785
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: