Healthcare Provider Details

I. General information

NPI: 1629351747
Provider Name (Legal Business Name): JDC ULTRASOUND DIAGNOSTICS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 DEMOTT AVE
CLIFTON NJ
07011-3311
US

IV. Provider business mailing address

199 DEMOTT AVE
CLIFTON NJ
07011-3311
US

V. Phone/Fax

Practice location:
  • Phone: 973-997-1549
  • Fax:
Mailing address:
  • Phone: 973-997-1549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: MR. JUAN DELACRUZ
Title or Position: PRESIDENT
Credential:
Phone: 973-997-1549