33D2091495 CLIA NUMBER - JEROME MEDICAL PC

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Laboratory Demographics

CLIA Number: 33D2091495

Facility Name: JEROME MEDICAL PC

Facility Address:
2386 JEROME AVENUE, 3RD FLOOR
BRONX, NY
ZIP 10468
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Facility Phone Number: 917 801-4360

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1689981094

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2091495
LAB Type	Physician Office
Facility Name	JEROME MEDICAL PC
Street	2386 JEROME AVENUE, 3RD FLOOR
City	BRONX
State	NY
ZIP	10468
Phone	917 801-4360
CertificateType	4
CertificateEffectiveDate	2/13/2023
CertificateExpirationDate	2/12/2025
FacilityType	Waiver

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