31D2086933 CLIA NUMBER - CITY MD 539 N MAIN ST LANOKA HARBOR

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Laboratory Demographics

CLIA Number: 31D2086933

Facility Name: CITY MD 539 N MAIN ST LANOKA HARBOR

Facility Address:
539 N MAIN STREET
LANOKA HARBOR, NJ
ZIP 08734
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Facility Phone Number: 609 488-6626

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1316511165

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	31D2086933
LAB Type	Physician Office
Facility Name	CITY MD 539 N MAIN ST LANOKA HARBOR
Street	539 N MAIN STREET
City	LANOKA HARBOR
State	NJ
ZIP	08734
Phone	609 488-6626
CertificateType	4
CertificateEffectiveDate	11/14/2022
CertificateExpirationDate	11/13/2024
FacilityType	Waiver

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