Provider Demographics
NPI:1588693469
Name:INFINITY DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:INFINITY DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FEDELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-630-9600
Mailing Address - Street 1:3450 NORTHLAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1709
Mailing Address - Country:US
Mailing Address - Phone:561-630-6900
Mailing Address - Fax:561-630-9644
Practice Address - Street 1:3450 NORTHLAKE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1709
Practice Address - Country:US
Practice Address - Phone:561-630-6900
Practice Address - Fax:561-630-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6647293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6178AMedicare ID - Type UnspecifiedPROVIDER ID