31D1018653 CLIA NUMBER - RIVERDEL MEDICAL PRACTICE PC

Laboratory Demographics

  • CLIA Code: 31D1018653
  • Facility Name: RIVERDEL MEDICAL PRACTICE PC
  • Facility Address: 302 CLAY STREET
    RIVERSIDE, NJ
    ZIP 08075
  • Facility Phone: 856 461-7955
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EVACUETO D. TANGO MD
  • NPI Number: 1487693164
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 31D1018653
LAB Type Physician Office
Facility Name RIVERDEL MEDICAL PRACTICE PC
Street 302 CLAY STREET
City RIVERSIDE
State NJ
ZIP 08075
Phone 856 461-7955
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/28/2023
Certificate Expiration Date 10/27/2025
Facility Type Physician Office
Lab Director EVACUETO D. TANGO MD

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