31D1007826 CLIA NUMBER - PRIMARY CARE MEDICAL PRACTICE LLC

Laboratory Demographics

  • CLIA Code: 31D1007826
  • Facility Name: PRIMARY CARE MEDICAL PRACTICE LLC
  • Facility Address: 1031 MC BRIDE AVENUE SUITE 205D
    WEST PATERSON, NJ
    ZIP 07424
  • Facility Phone: 973 237-9055
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANDREA C. SCUDDER
  • NPI Number: 1912113002
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 31D1007826
LAB Type Physician Office
Facility Name PRIMARY CARE MEDICAL PRACTICE LLC
Street 1031 MC BRIDE AVENUE SUITE 205D
City WEST PATERSON
State NJ
ZIP 07424
Phone 973 237-9055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/2/2025
Certificate Expiration Date 1/1/2027
Facility Type Physician Office
Lab Director ANDREA C. SCUDDER

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