31D2216279 CLIA NUMBER - SHORE BREAK RECOVERY LLC

Laboratory Demographics

  • CLIA Code: 31D2216279
  • Facility Name: SHORE BREAK RECOVERY LLC
  • Facility Address: 6 CHESTNUT STREET UNIT 9
    SOMERS POINT, NJ
    ZIP 08244
  • Facility Phone: 609 709-0244
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: IAN KOCH
  • NPI Number: 1407438823
  • Taxonomy: 261QM0850X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 31D2216279
LAB Type Comp. Outpatient Rehab Facility
Facility Name SHORE BREAK RECOVERY LLC
Street 6 CHESTNUT STREET UNIT 9
City SOMERS POINT
State NJ
ZIP 08244
Phone 609 709-0244
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2025
Certificate Expiration Date 3/10/2027
Facility Type Comp. Outpatient Rehab Facility
Lab Director IAN KOCH

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