Provider Demographics
NPI:1447496195
Name:DIAGNOSTIC MOBILE IMAGING,LLC
Entity type:Organization
Organization Name:DIAGNOSTIC MOBILE IMAGING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-423-4603
Mailing Address - Street 1:192 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PERTHAMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861
Mailing Address - Country:US
Mailing Address - Phone:732-376-1800
Mailing Address - Fax:732-376-1804
Practice Address - Street 1:2333 MORRIS AVE
Practice Address - Street 2:STE C-3
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:732-376-1800
Practice Address - Fax:732-376-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD070784002085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ102911Medicare PIN