31D2032906 CLIA NUMBER - JEFFREY B WISE, MD, FACS

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Laboratory Demographics

CLIA Number: 31D2032906

Facility Name: JEFFREY B WISE, MD, FACS

Facility Address:
1680 RT 23 SUITE 120
WAYNE, NJ
ZIP 07470
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Facility Phone Number: 973 305-1400

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1760698716

Taxonomy: 207YS0123X - Otolaryngology
An otolaryngologist who specializes in facial plastic surgery.

CLIA Record

Field Name	Field Value
CLIA Number	31D2032906
LAB Type	Physician Office
Facility Name	JEFFREY B WISE, MD, FACS
Street	1680 RT 23 SUITE 120
City	WAYNE
State	NJ
ZIP	07470
Phone	973 305-1400
CertificateType	4
CertificateEffectiveDate	11/17/2023
CertificateExpirationDate	11/16/2025
FacilityType	Waiver

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