31D2167195 CLIA NUMBER - SOVEREIGN MEDICAL GROUP LLC

Laboratory Demographics

CLIA Number: 31D2167195

Facility Name: SOVEREIGN MEDICAL GROUP LLC

Facility Address:
2255 JFK BLVD
JERSEY CITY, NJ
ZIP 07304
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Facility Phone Number: 201 855-8477

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1184095754

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	31D2167195
LAB Type	Physician Office
Facility Name	SOVEREIGN MEDICAL GROUP LLC
Street	2255 JFK BLVD
City	JERSEY CITY
State	NJ
ZIP	07304
Phone	201 855-8477
CertificateType	4
CertificateEffectiveDate	6/4/2023
CertificateExpirationDate	6/3/2025
FacilityType	Waiver

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