Healthcare Provider Details

I. General information

NPI: 1528753993
Provider Name (Legal Business Name): DYNAMIC MEDICAL IMAGING-DMI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W CHESTNUT ST
UNION NJ
07083-6966
US

IV. Provider business mailing address

950 W CHESTNUT ST
UNION NJ
07083-6966
US

V. Phone/Fax

Practice location:
  • Phone: 908-687-2552
  • Fax:
Mailing address:
  • Phone: 908-687-2552
  • Fax: 908-687-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IMRAN ANSARI
Title or Position: CEO
Credential:
Phone: 732-666-7206