31D1061681 CLIA NUMBER - PREMISE HEALTH OF NEW JERSEY MEDICAL, PC

Laboratory Demographics

CLIA Number: 31D1061681

Facility Name: PREMISE HEALTH OF NEW JERSEY MEDICAL, PC

Facility Address:
555 COLLEGE ROAD EAST
PRINCETON, NJ
ZIP 08543
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Facility Phone Number: 609 419-8564

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1205438520

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	31D1061681
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF NEW JERSEY MEDICAL, PC
Street	555 COLLEGE ROAD EAST
City	PRINCETON
State	NJ
ZIP	08543
Phone	609 419-8564
CertificateType	4
CertificateEffectiveDate	11/27/2022
CertificateExpirationDate	11/26/2024
FacilityType	Waiver

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