31D1037839 CLIA NUMBER - OPTUM MEDICAL CARE OF NJ PC

Laboratory Demographics

  • CLIA Code: 31D1037839
  • Facility Name: OPTUM MEDICAL CARE OF NJ PC
  • Facility Address: 28 THROCKMORTON LANE
    OLD BRIDGE, NJ
    ZIP 08857
  • Facility Phone: 732 727-6558
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAMARAO S. GAJULA
  • NPI Number: 1801843297
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 31D1037839
LAB Type Physician Office
Facility Name OPTUM MEDICAL CARE OF NJ PC
Street 28 THROCKMORTON LANE
City OLD BRIDGE
State NJ
ZIP 08857
Phone 732 727-6558
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2025
Certificate Expiration Date 3/6/2027
Facility Type Physician Office
Lab Director RAMARAO S. GAJULA

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