Provider Demographics
NPI:1659846863
Name:DYNAMIC MOBILE XRAY SERVICES LLC
Entity Type:Organization
Organization Name:DYNAMIC MOBILE XRAY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSAHON
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUEBOR
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT(R)(RT)(MR)
Authorized Official - Phone:201-952-6420
Mailing Address - Street 1:3412 BLUESTONE LN
Mailing Address - Street 2:
Mailing Address - City:E STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8116
Mailing Address - Country:US
Mailing Address - Phone:201-952-6420
Mailing Address - Fax:
Practice Address - Street 1:3412 BLUESTONE LN
Practice Address - Street 2:
Practice Address - City:E STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8116
Practice Address - Country:US
Practice Address - Phone:201-952-6420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier