31D2147776 CLIA NUMBER - GENESIS ADDICTION AND BEHAVIORAL MEDICINE, LLC

Laboratory Demographics

CLIA Number: 31D2147776

Facility Name: GENESIS ADDICTION AND BEHAVIORAL MEDICINE, LLC

Facility Address:
122 MAIN STREET, SUITE 103
NEWTON, NJ
ZIP 07860
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Facility Phone Number: 973 862-4297

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1487141883

Taxonomy: 207QA0401X - Family Medicine
A family medicine physician who specializes in the diagnosis and treatment of addictions.

CLIA Record

Field Name	Field Value
CLIA Number	31D2147776
LAB Type	Physician Office
Facility Name	GENESIS ADDICTION AND BEHAVIORAL MEDICINE, LLC
Street	122 MAIN STREET, SUITE 103
City	NEWTON
State	NJ
ZIP	07860
Phone	973 862-4297
CertificateType	4
CertificateEffectiveDate	4/26/2022
CertificateExpirationDate	4/25/2024
FacilityType	Waiver

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