31D1013070 CLIA NUMBER - CRESCENT INTERNAL MEDICINE GROUP LLC

Laboratory Demographics

  • CLIA Code: 31D1013070
  • Facility Name: CRESCENT INTERNAL MEDICINE GROUP LLC
  • Facility Address: 98 PARK STREET
    MONTCLAIR, NJ
    ZIP 07042
  • Facility Phone: 973 783-0800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD T. KRUPP DO
  • NPI Number: 1790886885
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 31D1013070
LAB Type Physician Office
Facility Name CRESCENT INTERNAL MEDICINE GROUP LLC
Street 98 PARK STREET
City MONTCLAIR
State NJ
ZIP 07042
Phone 973 783-0800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/29/2025
Certificate Expiration Date 5/28/2027
Facility Type Physician Office
Lab Director EDWARD T. KRUPP DO

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This page was last updated on: 6/4/2025