31D2294146 CLIA NUMBER - MEDALLION BEHAVIORAL HEALTH

Laboratory Demographics

  • CLIA Code: 31D2294146
  • Facility Name: MEDALLION BEHAVIORAL HEALTH
  • Facility Address: 207 19TH STREET
    PATERSON, NJ
    ZIP 07504
  • Facility Phone: 973 473-2343
  • Facility Type: Other - OUTPATIENT SUBSTANCE USE
  • Facility Type: Waiver
  • Lab Director: JACOB H. JACOBY
  • NPI Number: 1548311301
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 31D2294146
LAB Type Other - OUTPATIENT SUBSTANCE USE
Facility Name MEDALLION BEHAVIORAL HEALTH
Street 207 19TH STREET
City PATERSON
State NJ
ZIP 07504
Phone 973 473-2343
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/20/2023
Certificate Expiration Date 11/19/2025
Facility Type Other - OUTPATIENT SUBSTANCE USE
Lab Director JACOB H. JACOBY

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This page was last updated on: 6/4/2025