Healthcare Provider Details

I. General information

NPI: 1275763120
Provider Name (Legal Business Name): DIAMOND MOBILE ULTRASOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 JORALEMON ST
BELLEVILLE NJ
07109-2678
US

IV. Provider business mailing address

201 JORALEMON ST
BELLEVILLE NJ
07109-2678
US

V. Phone/Fax

Practice location:
  • Phone: 973-932-6869
  • Fax:
Mailing address:
  • Phone: 973-932-6869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE ELIZABETH GUAMAN
Title or Position: ULTRASOUND TECHNOLOGIST
Credential:
Phone: 973-932-6869