14D1047511 CLIA NUMBER - PARK AVENUE PRIVATE PRACTICE LLC

Laboratory Demographics

  • CLIA Code: 14D1047511
  • Facility Name: PARK AVENUE PRIVATE PRACTICE LLC
  • Facility Address: 767 PARK AVENUE W, SUITE 320
    HIGHLAND PARK, IL
    ZIP 60035
  • Facility Phone: 847 433-5505
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEFFREY S. GARLAND, MD
  • NPI Number: 1851763213
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D1047511
LAB Type Physician Office
Facility Name PARK AVENUE PRIVATE PRACTICE LLC
Street 767 PARK AVENUE W, SUITE 320
City HIGHLAND PARK
State IL
ZIP 60035
Phone 847 433-5505
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/7/2023
Certificate Expiration Date 11/6/2025
Facility Type Physician Office
Lab Director JEFFREY S. GARLAND, MD

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This page was last updated on: 9/29/2025