Provider Demographics
NPI:1710740485
Name:INFIINIHEALTH IPA, LLC
Entity Type:Organization
Organization Name:INFIINIHEALTH IPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:POGODIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-981-0020
Mailing Address - Street 1:17 BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-3203
Mailing Address - Country:US
Mailing Address - Phone:201-981-0020
Mailing Address - Fax:
Practice Address - Street 1:776 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1140
Practice Address - Country:US
Practice Address - Phone:973-324-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization