Provider Demographics
NPI:1710141353
Name:INFINITY DIAGNOSTIC GROUP, LLC
Entity Type:Organization
Organization Name:INFINITY DIAGNOSTIC GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-870-6377
Mailing Address - Street 1:450 SHREWSBURY PLZ # 376
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4325
Mailing Address - Country:US
Mailing Address - Phone:732-870-6377
Mailing Address - Fax:732-571-0196
Practice Address - Street 1:450 SHREWSBURY PLZ # 376
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4325
Practice Address - Country:US
Practice Address - Phone:732-870-6377
Practice Address - Fax:732-571-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier