31D2252005 CLIA NUMBER - GREENVILLE PRIMARY CARE

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Laboratory Demographics

CLIA Number: 31D2252005

Facility Name: GREENVILLE PRIMARY CARE

Facility Address:
1825 JFK BLVD FIRST FLOOR
JERSEY CITY, NJ
ZIP 07305
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Facility Phone Number: 201 942-4545

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1679943088

Taxonomy: 164W00000X - Licensed Practical Nurse
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

CLIA Record

Field Name	Field Value
CLIA Number	31D2252005
LAB Type	Physician Office
Facility Name	GREENVILLE PRIMARY CARE
Street	1825 JFK BLVD FIRST FLOOR
City	JERSEY CITY
State	NJ
ZIP	07305
Phone	201 942-4545
CertificateType	4
CertificateEffectiveDate	2/8/2024
CertificateExpirationDate	2/7/2026
FacilityType	Waiver

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