Organization Active NPI

Dynamic Medical Imaging, LLC

  • Radiology Clinic/Center
  • Union, NJ
National Provider Identifier
1164111928
Registry record updated May 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
DYNAMIC MEDICAL IMAGING, LLC
Practice address
950 W Chestnut St
Union, NJ 07083-6966
Phone
(908) 687-2552
NPI assigned
May 5, 2023
Last updated
May 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Eliza Delafuentechavez
Title
Coo
Phone
(908) 687-2552

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X NU Primary
Sleep Disorder Diagnostic Clinic/Center 261QS1200X NU

Addresses

Primary practice location

950 W Chestnut St
Union, NJ 07083-6966

Mailing address

950 W Chestnut St
Union, NJ 07083-6966
Phone (908) 687-2552

Other identifiers 1

IdentifierTypeStateIssuer
23229OtherNJAMBULATORY CARE LICENSE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683244800000",
    "number": "1164111928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 W CHESTNUT ST",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070836966",
            "telephone_number": "908-687-2552",
            "fax_number": "908-505-9664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 W CHESTNUT ST",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070836966",
            "telephone_number": "908-687-2552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC MEDICAL IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-05",
        "last_updated": "2023-05-05",
        "certification_date": "2023-04-25",
        "status": "A",
        "authorized_official_last_name": "DELAFUENTECHAVEZ",
        "authorized_official_first_name": "ELIZA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "908-687-2552"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMBULATORY CARE LICENSE",
            "identifier": "23229",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Union, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.