Provider Demographics
NPI:1326094343
Name:INFINITY MEDICAL , P.C.
Entity Type:Organization
Organization Name:INFINITY MEDICAL , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHESTAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-332-8634
Mailing Address - Street 1:1200 GRAVESEND NECK RD
Mailing Address - Street 2:UNIT # LC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4256
Mailing Address - Country:US
Mailing Address - Phone:718-332-8634
Mailing Address - Fax:718-332-8637
Practice Address - Street 1:1200 GRAVESEND NECK RD
Practice Address - Street 2:UNIT # LC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4256
Practice Address - Country:US
Practice Address - Phone:718-332-8634
Practice Address - Fax:718-332-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02665685Medicaid
NY060SR1Medicare ID - Type Unspecified
NY02665685Medicaid