31D2231299 CLIA NUMBER - SOUTH JERSEY VASCULAR INSTITUTE

Laboratory Demographics

CLIA Number: 31D2231299

Facility Name: SOUTH JERSEY VASCULAR INSTITUTE

Facility Address:
200 CENTURY PARKWAY, SUITE D
MOUNT LAUREL, NJ
ZIP 08054
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Facility Phone Number: 856 482-2800

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1861913220

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	31D2231299
LAB Type	Physician Office
Facility Name	SOUTH JERSEY VASCULAR INSTITUTE
Street	200 CENTURY PARKWAY, SUITE D
City	MOUNT LAUREL
State	NJ
ZIP	08054
Phone	856 482-2800
CertificateType	4
CertificateEffectiveDate	8/2/2023
CertificateExpirationDate	8/1/2025
FacilityType	Waiver

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