Provider Demographics
NPI:1023136652
Name:DIAGNOSTIC MEDICAL CONSULTANTS INC.
Entity type:Organization
Organization Name:DIAGNOSTIC MEDICAL CONSULTANTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-536-8100
Mailing Address - Street 1:23 KILMER DR
Mailing Address - Street 2:BUILDING ONE SUITE E
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1563
Mailing Address - Country:US
Mailing Address - Phone:732-536-8100
Mailing Address - Fax:732-536-8843
Practice Address - Street 1:55 MEADOWLANDS PKWY
Practice Address - Street 2:AT MEADOWLANDS HOSPITAL MEDICAL CENTER
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2977
Practice Address - Country:US
Practice Address - Phone:201-325-9111
Practice Address - Fax:201-325-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22520261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8040605Medicaid
NJ8040605Medicaid