Healthcare Provider Details

I. General information

NPI: 1710141353
Provider Name (Legal Business Name): INFINITY DIAGNOSTIC GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SHREWSBURY PLZ # 376
SHREWSBURY NJ
07702-4325
US

IV. Provider business mailing address

450 SHREWSBURY PLZ # 376
SHREWSBURY NJ
07702-4325
US

V. Phone/Fax

Practice location:
  • Phone: 732-870-6377
  • Fax: 732-571-0196
Mailing address:
  • Phone: 732-870-6377
  • Fax: 732-571-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: LYDIA WIKOFF
Title or Position: MANAGER
Credential:
Phone: 732-870-6377