Provider Demographics
NPI:1851158182
Name:INFINIHEALTH MEDICAL GROUP
Entity Type:Organization
Organization Name:INFINIHEALTH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSIBOROD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-982-4706
Mailing Address - Street 1:776 NORTHFIELD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1140
Mailing Address - Country:US
Mailing Address - Phone:201-982-4706
Mailing Address - Fax:
Practice Address - Street 1:776 NORTHFIELD AVE STE 101
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:2024-03-04
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty