31D2200973 CLIA NUMBER - INTEGRATED MEDICAL CARE, LLC

Laboratory Demographics

  • CLIA Code: 31D2200973
  • Facility Name: INTEGRATED MEDICAL CARE, LLC
  • Facility Address: 5600 JFK BLVD E
    WEST NEW YORK, NJ
    ZIP 07093
  • Facility Phone: 201 969-9500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THOMAS P. RAGUKONIS
  • NPI Number: 1669577318
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 31D2200973
LAB Type Physician Office
Facility Name INTEGRATED MEDICAL CARE, LLC
Street 5600 JFK BLVD E
City WEST NEW YORK
State NJ
ZIP 07093
Phone 201 969-9500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2024
Certificate Expiration Date 11/17/2026
Facility Type Physician Office
Lab Director THOMAS P. RAGUKONIS

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