31D2139631 CLIA NUMBER - DR MIRIC NEUROLOGY CENTER

Laboratory Demographics

CLIA Number: 31D2139631

Facility Name: DR MIRIC NEUROLOGY CENTER

Facility Address:
35 W MAIN STREET, SUITE 103
DENVILLE, NJ
ZIP 07834
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Facility Phone Number: 973 625-0858

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1346417409

Taxonomy: 2084N0400X - Psychiatry & Neurology
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.

CLIA Record

Field Name	Field Value
CLIA Number	31D2139631
LAB Type	Physician Office
Facility Name	DR MIRIC NEUROLOGY CENTER
Street	35 W MAIN STREET, SUITE 103
City	DENVILLE
State	NJ
ZIP	07834
Phone	973 625-0858
CertificateType	4
CertificateEffectiveDate	11/6/2023
CertificateExpirationDate	11/5/2025
FacilityType	Waiver

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