31D1091092 CLIA NUMBER - PRUDENTMD LLC

Laboratory Demographics

CLIA Number: 31D1091092

Facility Name: PRUDENTMD LLC

Facility Address:
5 DUNDEE AVE
ISELIN, NJ
ZIP 08830
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Facility Phone Number: 732 404-0044

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1457524217

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	31D1091092
LAB Type	Physician Office
Facility Name	PRUDENTMD LLC
Street	5 DUNDEE AVE
City	ISELIN
State	NJ
ZIP	08830
Phone	732 404-0044
CertificateType	4
CertificateEffectiveDate	10/24/2022
CertificateExpirationDate	10/23/2024
FacilityType	Waiver

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