Organization
DYNAMIC MEDICAL IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZA DELAFUENTECHAVEZ (COO)
(908) 687-2552
Entity
Organization
Contact information
Practice address
950 W CHESTNUT ST, UNION, NJ 07083-6966
(908) 687-2552
Mailing address
950 W CHESTNUT ST, UNION, NJ 07083-6966
(908) 687-2552
(908) 505-9664
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23229
AMBULATORY CARE LICENSE
NJ
Enumeration date
05/05/2023
Last updated
05/05/2023
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