31D2321162 CLIA NUMBER - EVERGREEN MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 31D2321162
  • Facility Name: EVERGREEN MEDICAL GROUP
  • Facility Address: 887 KINDERKAMACK ROAD
    RIVER EDGE, NJ
    ZIP 07661
  • Facility Phone: 201 464-0860
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VASYL PIDKAMINETSKIY
  • NPI Number: 1295516409
  • Taxonomy: 208100000X - Physical Medicine & Rehabilitation

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 31D2321162
LAB Type Physician Office
Facility Name EVERGREEN MEDICAL GROUP
Street 887 KINDERKAMACK ROAD
City RIVER EDGE
State NJ
ZIP 07661
Phone 201 464-0860
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2025
Certificate Expiration Date 3/30/2027
Facility Type Physician Office
Lab Director VASYL PIDKAMINETSKIY

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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