31D2276707 CLIA NUMBER - PRODIGY AESTHETICS AND PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 31D2276707
  • Facility Name: PRODIGY AESTHETICS AND PRIMARY CARE
  • Facility Address: 680 BROADWAY SUITE 205
    PATERSON, NJ
    ZIP 07514
  • Facility Phone: 973 221-5527
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: CAROLYN CEDENO
  • NPI Number: 1437856648
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 31D2276707
LAB Type Practitioner Other
Facility Name PRODIGY AESTHETICS AND PRIMARY CARE
Street 680 BROADWAY SUITE 205
City PATERSON
State NJ
ZIP 07514
Phone 973 221-5527
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/14/2025
Certificate Expiration Date 2/13/2027
Facility Type Practitioner Other
Lab Director CAROLYN CEDENO

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