31D0111383 CLIA NUMBER - HAWTHORNE FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 31D0111383

Facility Name: HAWTHORNE FAMILY PRACTICE

Facility Address:
1083 GOFFLE ROAD
HAWTHORNE, NJ
ZIP 07506
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Facility Phone Number: 973 427-2421

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1588878300

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	31D0111383
LAB Type	Physician Office
Facility Name	HAWTHORNE FAMILY PRACTICE
Street	1083 GOFFLE ROAD
City	HAWTHORNE
State	NJ
ZIP	07506
Phone	973 427-2421
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024