Provider Demographics
NPI:1780121723
Name:INFANTINO, DORIAN (MD)
Entity type:Individual
Prefix:
First Name:DORIAN
Middle Name:
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 1:51 FRENCH ST
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY, RWJMS
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1921
Mailing Address - Country:US
Mailing Address - Phone:215-590-1220
Mailing Address - Fax:
Practice Address - Street 1:51 FRENCH ST
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY, RWJMS
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1921
Practice Address - Country:US
Practice Address - Phone:215-590-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-29
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10505600207ZP0102X
PAMD459887208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics