31D1095699 CLIA NUMBER - BERGEN VOLUNTEER MEDICAL INITIATIVE INC

Laboratory Demographics

CLIA Number: 31D1095699

Facility Name: BERGEN VOLUNTEER MEDICAL INITIATIVE INC

Facility Address:
75 ESSEX STREET, SUITE 100
HACKENSACK, NJ
ZIP 07601
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Facility Phone Number: 201 767-1443

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1972757755

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	31D1095699
LAB Type	Community Clinic
Facility Name	BERGEN VOLUNTEER MEDICAL INITIATIVE INC
Street	75 ESSEX STREET, SUITE 100
City	HACKENSACK
State	NJ
ZIP	07601
Phone	201 767-1443
CertificateType	4
CertificateEffectiveDate	2/13/2023
CertificateExpirationDate	2/12/2025
FacilityType	Waiver

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