31D2298145 CLIA NUMBER - AGILE INFUSION MEDICINE PC

Laboratory Demographics

  • CLIA Code: 31D2298145
  • Facility Name: AGILE INFUSION MEDICINE PC
  • Facility Address: 5 SUMMIT AVENUE, SUITE 204
    HACKENSACK, NJ
    ZIP 07601
  • Facility Phone: 201 751-2202
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONATHAN WIESEN
  • NPI Number: 1972382018
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 31D2298145
LAB Type Physician Office
Facility Name AGILE INFUSION MEDICINE PC
Street 5 SUMMIT AVENUE, SUITE 204
City HACKENSACK
State NJ
ZIP 07601
Phone 201 751-2202
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/30/2024
Certificate Expiration Date 1/29/2026
Facility Type Physician Office
Lab Director JONATHAN WIESEN

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