31D1093698 CLIA NUMBER - ADVANCED WELLNESS

Laboratory Demographics

CLIA Number: 31D1093698

Facility Name: ADVANCED WELLNESS

Facility Address:
17 NORTH MAIN STREET
MARLBORO, NJ
ZIP 07746
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Facility Phone Number: 732 431-2155

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295279297

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	31D1093698
LAB Type	Physician Office
Facility Name	ADVANCED WELLNESS
Street	17 NORTH MAIN STREET
City	MARLBORO
State	NJ
ZIP	07746
Phone	732 431-2155
CertificateType	4
CertificateEffectiveDate	12/30/2022
CertificateExpirationDate	12/29/2024
FacilityType	Waiver

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