31D2040770 CLIA NUMBER - KENILWORTH PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 31D2040770
  • Facility Name: KENILWORTH PRIMARY CARE
  • Facility Address: 66 SOUTH 21ST STREET
    KENILWORTH, NJ
    ZIP 07033
  • Facility Phone: 908 276-9595
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BHAVANI JEEREDDY
  • NPI Number: 1164793014
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 31D2040770
LAB Type Physician Office
Facility Name KENILWORTH PRIMARY CARE
Street 66 SOUTH 21ST STREET
City KENILWORTH
State NJ
ZIP 07033
Phone 908 276-9595
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2024
Certificate Expiration Date 5/8/2026
Facility Type Physician Office
Lab Director BHAVANI JEEREDDY

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