31D0880615 CLIA NUMBER - COSULICH DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 31D0880615
  • Facility Name: COSULICH DERMATOLOGY
  • Facility Address: 3350 HWY 138 WEST BLD 2, STE 122
    WALL, NJ
    ZIP 07719
  • Facility Phone: 732 280-1200
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: MICHAEL T. COSULICH
  • NPI Number: 1427333632
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 31D0880615
LAB Type Physician Office
Facility Name COSULICH DERMATOLOGY
Street 3350 HWY 138 WEST BLD 2, STE 122
City WALL
State NJ
ZIP 07719
Phone 732 280-1200
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 9/29/2024
Certificate Expiration Date 9/28/2026
Facility Type Physician Office
Lab Director MICHAEL T. COSULICH

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