Organization
EXECUTIVE DIAGNOSIS SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANA VIRGINIA DELACRUZ (OWNER)
(551) 587-1150
Entity
Organization
Contact information
Practice address
39 AYCRIGG AVENUE, PASSAIC, NJ 07055
(551) 587-1150
(973) 777-1636
Mailing address
39 AYCRIGG AVENUE, PASSAIC, NJ 07055
(551) 587-1150
(973) 777-1636
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
—
—
Other
Enumeration date
06/30/2010
Last updated
06/30/2010
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