31D0115823 CLIA NUMBER - ITA SCOLNICK MD

Laboratory Demographics

  • CLIA Code: 31D0115823
  • Facility Name: ITA SCOLNICK MD
  • Facility Address: 447 RTE 10 SUITE 16
    RANDOLPH, NJ
    ZIP 07869
  • Facility Phone: 201 361-2860
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ITA SCOLNICK
  • NPI Number: 1194768580
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 31D0115823
LAB Type Physician Office
Facility Name ITA SCOLNICK MD
Street 447 RTE 10 SUITE 16
City RANDOLPH
State NJ
ZIP 07869
Phone 201 361-2860
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/24/2025
Certificate Expiration Date 1/23/2027
Facility Type Physician Office
Lab Director ITA SCOLNICK

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