Provider Demographics
NPI:1558051656
Name:TLC IMAGING GROUP , LLC
Entity Type:Organization
Organization Name:TLC IMAGING GROUP , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAFUENTECHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-425-8919
Mailing Address - Street 1:950 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6966
Mailing Address - Country:US
Mailing Address - Phone:908-425-8919
Mailing Address - Fax:908-505-9664
Practice Address - Street 1:950 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6966
Practice Address - Country:US
Practice Address - Phone:908-425-8919
Practice Address - Fax:908-505-9664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic