31D2169258 CLIA NUMBER - ATLANTIC BREAST ASSOC - OVERLOOK MED CENTER

Laboratory Demographics

CLIA Number: 31D2169258

Facility Name: ATLANTIC BREAST ASSOC - OVERLOOK MED CENTER

Facility Address:
11 OVERLOOK ROAD, MACII, SUITE LL 102
SUMMIT, NJ
ZIP 07901
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Facility Phone Number: 908 598-6576

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1942787981

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	31D2169258
LAB Type	Physician Office
Facility Name	ATLANTIC BREAST ASSOC - OVERLOOK MED CENTER
Street	11 OVERLOOK ROAD, MACII, SUITE LL 102
City	SUMMIT
State	NJ
ZIP	07901
Phone	908 598-6576
CertificateType	4
CertificateEffectiveDate	7/17/2023
CertificateExpirationDate	7/16/2025
FacilityType	Waiver

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