Healthcare Provider Details

I. General information

NPI: 1164645404
Provider Name (Legal Business Name): MARY INFANTINO APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 FULTON AVE
HEMPSTEAD NY
11550-4364
US

IV. Provider business mailing address

6 E SLOPE RD
BAYVILLE NY
11709-2112
US

V. Phone/Fax

Practice location:
  • Phone: 516-750-2500
  • Fax: 516-483-3592
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberF3006741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: