Provider Demographics
NPI:1720141526
Name:INFANTINO, ANTHONY GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GERARD
Last Name:INFANTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MICHAEL WAY
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563-2939
Mailing Address - Country:US
Mailing Address - Phone:845-878-3955
Mailing Address - Fax:
Practice Address - Street 1:425 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-2517
Practice Address - Country:US
Practice Address - Phone:860-947-0322
Practice Address - Fax:860-947-0324
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0417852081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY158626-1OtherLICENSE #
CT34284OtherCSRP #
CT041785OtherLICENSE #
CT041785OtherLICENSE #
CT34284OtherCSRP #
A65180Medicare UPIN