31D0116602 CLIA NUMBER - MENDHAM MEDICAL PRACTICE, LLC

Laboratory Demographics

  • CLIA Code: 31D0116602
  • Facility Name: MENDHAM MEDICAL PRACTICE, LLC
  • Facility Address: 19 E MAIN STREET
    MENDHAM, NJ
    ZIP 07945
  • Facility Phone: (973) 543-6505
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: GREGG G. MARELLA
  • NPI Number: 1265917926
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 31D0116602
LAB Type Physician Office
Facility Name MENDHAM MEDICAL PRACTICE, LLC
Street 19 E MAIN STREET
City MENDHAM
State NJ
ZIP 07945
Phone 9735436505
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/18/2025
Certificate Expiration Date 8/17/2027
Facility Type Physician Office
Lab Director GREGG G. MARELLA

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This page was last updated on: 5/18/2026