31D2225469 CLIA NUMBER - ELITE CONCIERGE MEDICINE

Laboratory Demographics

  • CLIA Code: 31D2225469
  • Facility Name: ELITE CONCIERGE MEDICINE
  • Facility Address: 414 EAGLE ROCK AVENUE SUITE 105
    WEST ORANGE, NJ
    ZIP 07052
  • Facility Phone: 973 736-1365
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMIE BAUX-JOHNSON
  • NPI Number: 1548087844
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 31D2225469
LAB Type Physician Office
Facility Name ELITE CONCIERGE MEDICINE
Street 414 EAGLE ROCK AVENUE SUITE 105
City WEST ORANGE
State NJ
ZIP 07052
Phone 973 736-1365
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2025
Certificate Expiration Date 5/20/2027
Facility Type Physician Office
Lab Director JAMIE BAUX-JOHNSON

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