31D2114503 CLIA NUMBER - SUMMIT MEDICAL GROUP DBA CITYMD

Laboratory Demographics

CLIA Number: 31D2114503

Facility Name: SUMMIT MEDICAL GROUP DBA CITYMD

Facility Address:
1825 ROUTE 35
WALL, NJ
ZIP 07719
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Facility Phone Number: 732 280-2600

Facility Type: Other - URGENT CARE FACILITY

Certificate Type: Waiver

NPI Number: 1740854587

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	31D2114503
LAB Type	Other - URGENT CARE FACILITY
Facility Name	SUMMIT MEDICAL GROUP DBA CITYMD
Street	1825 ROUTE 35
City	WALL
State	NJ
ZIP	07719
Phone	732 280-2600
CertificateType	4
CertificateEffectiveDate	6/15/2022
CertificateExpirationDate	6/14/2024
FacilityType	Waiver

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