31D2122777 CLIA NUMBER - HACKENSACK UNIVERSITY MEDICAL GROUP PEDIATRIC ADOLESCENT MEDICINE

Laboratory Demographics

  • CLIA Code: 31D2122777
  • Facility Name: HACKENSACK UNIVERSITY MEDICAL GROUP PEDIATRIC ADOLESCENT MEDICINE
  • Facility Address: 30 PROSPECT AVENUE WFAN BUILDING, THIRD FLOOR
    HACKENSACK, NJ
    ZIP 07601
  • Facility Phone: 551 996-2237
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JENNIFER L. NORTHRIDGE
  • NPI Number: 1184649345
  • Taxonomy: 282NC2000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 31D2122777
LAB Type Physician Office
Facility Name HACKENSACK UNIVERSITY MEDICAL GROUP PEDIATRIC ADOLESCENT MEDICINE
Street 30 PROSPECT AVENUE WFAN BUILDING, THIRD FLOOR
City HACKENSACK
State NJ
ZIP 07601
Phone 551 996-2237
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2025
Certificate Expiration Date 3/30/2027
Facility Type Physician Office
Lab Director JENNIFER L. NORTHRIDGE

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