Healthcare Provider Details

I. General information

NPI: 1174821953
Provider Name (Legal Business Name): JERSEY CITY DIAGNOSTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 KENNEDY BLVD
JERSEY CITY NJ
07304-1510
US

IV. Provider business mailing address

2300 KENNEDY BLVD
JERSEY CITY NJ
07304-1510
US

V. Phone/Fax

Practice location:
  • Phone: 201-432-2100
  • Fax: 201-432-1900
Mailing address:
  • Phone: 201-432-2100
  • Fax: 201-432-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMY HANNA YOUSSEF
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 732-533-8264