31D2158609 CLIA NUMBER - OLD BERGEN PEDIATRICS

Laboratory Demographics

  • CLIA Code: 31D2158609
  • Facility Name: OLD BERGEN PEDIATRICS
  • Facility Address: 4 HIGHLAND AVENUE
    JERSEY CITY, NJ
    ZIP 07306
  • Facility Phone: 201 434-3997
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NELO DIMACULANGAN
  • NPI Number: 1053541599
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 31D2158609
LAB Type Physician Office
Facility Name OLD BERGEN PEDIATRICS
Street 4 HIGHLAND AVENUE
City JERSEY CITY
State NJ
ZIP 07306
Phone 201 434-3997
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2024
Certificate Expiration Date 12/2/2026
Facility Type Physician Office
Lab Director NELO DIMACULANGAN

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