31D0111661 CLIA NUMBER - HACKENSACK PEDIATRICS

Laboratory Demographics

  • CLIA Code: 31D0111661
  • Facility Name: HACKENSACK PEDIATRICS
  • Facility Address: 177 SUMMIT AVE
    HACKENSACK, NJ
    ZIP 07601
  • Facility Phone: 201 487-8222
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MONA M. TANTAWI
  • NPI Number: 1831264316
  • Taxonomy: 261QC1800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 31D0111661
LAB Type Physician Office
Facility Name HACKENSACK PEDIATRICS
Street 177 SUMMIT AVE
City HACKENSACK
State NJ
ZIP 07601
Phone 201 487-8222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2025
Certificate Expiration Date 9/19/2027
Facility Type Physician Office
Lab Director MONA M. TANTAWI

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