31D2277459 CLIA NUMBER - HACKENSACK MERIDIAN HEALTH MEDICAL GROUP PRIMARY CARE, PC

Laboratory Demographics

CLIA Number: 31D2277459

Facility Name: HACKENSACK MERIDIAN HEALTH MEDICAL GROUP PRIMARY CARE, PC

Facility Address:
19 DAVIS AVE 6TH FLOOR
NEPTUNE, NJ
ZIP 07753
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Facility Phone Number: 732 897-3990

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1932763091

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	31D2277459
LAB Type	Physician Office
Facility Name	HACKENSACK MERIDIAN HEALTH MEDICAL GROUP PRIMARY CARE, PC
Street	19 DAVIS AVE 6TH FLOOR
City	NEPTUNE
State	NJ
ZIP	07753
Phone	732 897-3990
CertificateType	4
CertificateEffectiveDate	2/28/2023
CertificateExpirationDate	2/27/2025
FacilityType	Waiver

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