31D2304489 CLIA NUMBER - ENIDAMMY FAMILY PRACTICE LLC

Laboratory Demographics

  • CLIA Code: 31D2304489
  • Facility Name: ENIDAMMY FAMILY PRACTICE LLC
  • Facility Address: 2177 OAK TREE RD STE 206
    EDISON, NJ
    ZIP 08820
  • Facility Phone: 908 755-4000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEHINDE W. IBITOLA
  • NPI Number: 1548906837
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 31D2304489
LAB Type Physician Office
Facility Name ENIDAMMY FAMILY PRACTICE LLC
Street 2177 OAK TREE RD STE 206
City EDISON
State NJ
ZIP 08820
Phone 908 755-4000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2024
Certificate Expiration Date 5/13/2026
Facility Type Physician Office
Lab Director KEHINDE W. IBITOLA

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