31D1103467 CLIA NUMBER - PROSPECT PEDIATRICS PA

Laboratory Demographics

  • CLIA Code: 31D1103467
  • Facility Name: PROSPECT PEDIATRICS PA
  • Facility Address: 163 BELLEVILLE AVENUE
    BELLEVILLE, NJ
    ZIP 07109
  • Facility Phone: 973 302-4644
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GLORIA N. OKOH MD
  • NPI Number: 1023431871
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 31D1103467
LAB Type Physician Office
Facility Name PROSPECT PEDIATRICS PA
Street 163 BELLEVILLE AVENUE
City BELLEVILLE
State NJ
ZIP 07109
Phone 973 302-4644
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/11/2025
Certificate Expiration Date 8/10/2027
Facility Type Physician Office
Lab Director GLORIA N. OKOH MD

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This page was last updated on: 9/29/2025