39D0896604 CLIA NUMBER - BUSHKILL FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 39D0896604
  • Facility Name: BUSHKILL FAMILY PRACTICE
  • Facility Address: 487 MOORESTOWN RD SUITE 110
    WIND GAP, PA
    ZIP 18091
  • Facility Phone: 484 503-2055
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ELLEN M. DIDIMAMOFF
  • NPI Number: 1063463701
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D0896604
LAB Type Physician Office
Facility Name BUSHKILL FAMILY PRACTICE
Street 487 MOORESTOWN RD SUITE 110
City WIND GAP
State PA
ZIP 18091
Phone 484 503-2055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/13/2025
Certificate Expiration Date 1/12/2027
Facility Type Physician Office
Lab Director DR. ELLEN M. DIDIMAMOFF

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