Provider Demographics
NPI:1629351747
Name:JDC ULTRASOUND DIAGNOSTICS,LLC
Entity Type:Organization
Organization Name:JDC ULTRASOUND DIAGNOSTICS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-997-1549
Mailing Address - Street 1:199 DEMOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3311
Mailing Address - Country:US
Mailing Address - Phone:973-997-1549
Mailing Address - Fax:
Practice Address - Street 1:199 DEMOTT AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3311
Practice Address - Country:US
Practice Address - Phone:973-997-1549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty