31D0994093 CLIA NUMBER - VITA-MED FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 31D0994093

Facility Name: VITA-MED FAMILY PRACTICE

Facility Address:
3000 KENNEDY BOULEVARD, SUITE 308
JERSEY CITY, NJ
ZIP 07306
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Facility Phone Number: (201) 963-0800

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1962575167

Taxonomy: 207QA0000X - Family Medicine
A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs.

CLIA Record

Field Name	Field Value
CLIA Number	31D0994093
LAB Type	PHYSICIAN OFFICE
Facility Name	VITA-MED FAMILY PRACTICE
Street	3000 KENNEDY BOULEVARD, SUITE 308
City	JERSEY CITY
State	NJ
ZIP	07306
Phone	(201) 963-0800

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This page was last updated on: 5/11/2023