31D2138450 CLIA NUMBER - FORTLEE INTERNAL MEDICINE PC

Laboratory Demographics

  • CLIA Code: 31D2138450
  • Facility Name: FORTLEE INTERNAL MEDICINE PC
  • Facility Address: 1608 LEMOINE AVE, STE 206
    FORT LEE, NJ
    ZIP 07024
  • Facility Phone: 917 301-5821
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEONGWON KIM
  • NPI Number: 1952820623
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 31D2138450
LAB Type Physician Office
Facility Name FORTLEE INTERNAL MEDICINE PC
Street 1608 LEMOINE AVE, STE 206
City FORT LEE
State NJ
ZIP 07024
Phone 917 301-5821
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/18/2023
Certificate Expiration Date 10/17/2025
Facility Type Physician Office
Lab Director JEONGWON KIM

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