31D1005374 CLIA NUMBER - PREMISE HEALTH OF NEW JERSEY MEDICAL, PC

Laboratory Demographics

CLIA Number: 31D1005374

Facility Name: PREMISE HEALTH OF NEW JERSEY MEDICAL, PC

Facility Address:
100 BUSINESS PARK DRIVE BLOOMBERG HEALTH CENTER
PRINCETON, NJ
ZIP 08542
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Facility Phone Number: 484 351-3291

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1144638339

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	31D1005374
LAB Type	Ambulance
Facility Name	PREMISE HEALTH OF NEW JERSEY MEDICAL, PC
Street	100 BUSINESS PARK DRIVE BLOOMBERG HEALTH CENTER
City	PRINCETON
State	NJ
ZIP	08542
Phone	484 351-3291
CertificateType	4
CertificateEffectiveDate	10/21/2022
CertificateExpirationDate	10/20/2024
FacilityType	Waiver

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