31D1094599 CLIA NUMBER - JACKSON FAMILY PRACTICE, LLC

Laboratory Demographics

  • CLIA Code: 31D1094599
  • Facility Name: JACKSON FAMILY PRACTICE, LLC
  • Facility Address: 55 SCHANCK ROAD, SUITE A 20
    FREEHOLD, NJ
    ZIP 07728
  • Facility Phone: (732) 683-0010
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MIAH KIM
  • NPI Number: 1922244060
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 31D1094599
LAB Type Physician Office
Facility Name JACKSON FAMILY PRACTICE, LLC
Street 55 SCHANCK ROAD, SUITE A 20
City FREEHOLD
State NJ
ZIP 07728
Phone 7326830010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/22/2025
Certificate Expiration Date 1/21/2027
Facility Type Physician Office
Lab Director MIAH KIM

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This page was last updated on: 5/18/2026