NPIMap

Organization Active NPI

Infinite Well LLC

  • Clinic/Center
  • Bethany, CT
National Provider Identifier
1356798573
Registry record updated May 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
000258 Issued in CT
Legal business name
INFINITE WELL LLC
Practice address
286 Beacon Rd
Bethany, CT 06524-3080
Phone
(203) 537-0699
NPI assigned
May 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Boaz ItshakyNPI 1730218181
Title
Owner
Phone
(203) 537-0699

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 000258 CT Primary

Addresses

Primary practice location

286 Beacon Rd
Bethany, CT 06524-3080

Mailing address

286 Beacon Rd
Bethany, CT 06524-3080
Phone (203) 537-0699

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463443200000",
    "number": "1356798573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "286 BEACON RD",
            "city": "BETHANY",
            "state": "CT",
            "postal_code": "065243080",
            "telephone_number": "203-537-0699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "286 BEACON RD",
            "city": "BETHANY",
            "state": "CT",
            "postal_code": "065243080",
            "telephone_number": "203-537-0699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFINITE WELL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-17",
        "last_updated": "2016-05-17",
        "status": "A",
        "authorized_official_last_name": "ITSHAKY",
        "authorized_official_first_name": "BOAZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-537-0699"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CT",
            "license": "000258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethany, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.