31D2161131 CLIA NUMBER - HACKENSACK UNIVERSITY MEDICAL GROUP PC

Laboratory Demographics

CLIA Number: 31D2161131

Facility Name: HACKENSACK UNIVERSITY MEDICAL GROUP PC

Facility Address:
120 RIVER STREET
HACKENSACK, NJ
ZIP 07601
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Facility Phone Number: 201 489-2727

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1306864343

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	31D2161131
LAB Type	Physician Office
Facility Name	HACKENSACK UNIVERSITY MEDICAL GROUP PC
Street	120 RIVER STREET
City	HACKENSACK
State	NJ
ZIP	07601
Phone	201 489-2727
CertificateType	4
CertificateEffectiveDate	1/28/2023
CertificateExpirationDate	1/27/2025
FacilityType	Waiver

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