31D1054597 CLIA NUMBER - ETHERIDGE FAMILY MEDICINE LLC

Laboratory Demographics

CLIA Number: 31D1054597

Facility Name: ETHERIDGE FAMILY MEDICINE LLC

Facility Address:
81 VERONICA AVENUE SUITE 202
SOMERSET, NJ
ZIP 08873
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Facility Phone Number: 732 246-0057

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1700954476

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	31D1054597
LAB Type	Physician Office
Facility Name	ETHERIDGE FAMILY MEDICINE LLC
Street	81 VERONICA AVENUE SUITE 202
City	SOMERSET
State	NJ
ZIP	08873
Phone	732 246-0057
CertificateType	4
CertificateEffectiveDate	5/25/2022
CertificateExpirationDate	5/24/2024
FacilityType	Waiver

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