31D2298145 CLIA NUMBER - AGILE INFUSION MEDICINE PC

Laboratory Demographics

CLIA Number: 31D2298145

Facility Name: AGILE INFUSION MEDICINE PC

Facility Address:
5 SUMMIT AVENUE, SUITE 204
HACKENSACK, NJ
ZIP 07601
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Facility Phone Number: 201 751-2202

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1972382018

Taxonomy: 261QP2300X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	1/30/2024
CertificateExpirationDate	1/29/2026
FacilityType	Waiver

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