31D0949373 CLIA NUMBER - ELLEN BLACK MD

Laboratory Demographics

  • CLIA Code: 31D0949373
  • Facility Name: ELLEN BLACK MD
  • Facility Address: 946 AVENUE C
    BAYONNE, NJ
    ZIP 07002
  • Facility Phone: 201 858-0800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ELLEN BLACK MD
  • NPI Number: 1164594735
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 31D0949373
LAB Type Physician Office
Facility Name ELLEN BLACK MD
Street 946 AVENUE C
City BAYONNE
State NJ
ZIP 07002
Phone 201 858-0800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2024
Certificate Expiration Date 3/23/2026
Facility Type Physician Office
Lab Director ELLEN BLACK MD

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