31D0999926 CLIA NUMBER - OPTUM MEDICAL CARE OF NJ PC

Laboratory Demographics

CLIA Number: 31D0999926

Facility Name: OPTUM MEDICAL CARE OF NJ PC

Facility Address:
145 MAIN AVENUE, SUITE 203
PASSAIC, NJ
ZIP 07055
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Facility Phone Number: 973 591-1600

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1487193454

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	31D0999926
LAB Type	Physician Office
Facility Name	OPTUM MEDICAL CARE OF NJ PC
Street	145 MAIN AVENUE, SUITE 203
City	PASSAIC
State	NJ
ZIP	07055
Phone	973 591-1600
CertificateType	4
CertificateEffectiveDate	7/22/2023
CertificateExpirationDate	7/21/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024