31D0936554 CLIA NUMBER - ROBERT A PROVENCHER DO

Laboratory Demographics

  • CLIA Code: 31D0936554
  • Facility Name: ROBERT A PROVENCHER DO
  • Facility Address: 296 KINGS HIGHWAY
    CLARKSBORO, NJ
    ZIP 08020
  • Facility Phone: 609 423-7000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBERT A. PROVENCHER DO
  • NPI Number: 1669402152
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 31D0936554
LAB Type Physician Office
Facility Name ROBERT A PROVENCHER DO
Street 296 KINGS HIGHWAY
City CLARKSBORO
State NJ
ZIP 08020
Phone 609 423-7000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/25/2023
Certificate Expiration Date 11/24/2025
Facility Type Physician Office
Lab Director ROBERT A. PROVENCHER DO

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