31D2040770 CLIA NUMBER - KENILWORTH PRIMARY CARE

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Laboratory Demographics

CLIA Number: 31D2040770

Facility Name: KENILWORTH PRIMARY CARE

Facility Address:
66 SOUTH 21ST STREET
KENILWORTH, NJ
ZIP 07033
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Facility Phone Number: 908 276-9595

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1164793014

Taxonomy: 261QP2300X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	5/9/2024
CertificateExpirationDate	5/8/2026
FacilityType	Waiver

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