31D0993076 CLIA NUMBER - PINEBROOK MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 31D0993076
  • Facility Name: PINEBROOK MEDICAL CENTER
  • Facility Address: 170 CHANGEBRIDGE ROAD SUITE A3
    MONTVILLE, NJ
    ZIP 07045
  • Facility Phone: 973 808-3200
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THOMAS J. STACK DO
  • NPI Number: 1811205024
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 31D0993076
LAB Type Physician Office
Facility Name PINEBROOK MEDICAL CENTER
Street 170 CHANGEBRIDGE ROAD SUITE A3
City MONTVILLE
State NJ
ZIP 07045
Phone 973 808-3200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2023
Certificate Expiration Date 11/4/2025
Facility Type Physician Office
Lab Director THOMAS J. STACK DO

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