39D0900432 CLIA NUMBER - COMMONWEALTH HEALTH PHYSICIAN NETWORK

Laboratory Demographics

  • CLIA Code: 39D0900432
  • Facility Name: COMMONWEALTH HEALTH PHYSICIAN NETWORK
  • Facility Address: 4 EAST MAIN STREET
    NANTICOKE, PA
    ZIP 18634
  • Facility Phone: 570 258-3939
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MATTHEW N. KOZICKI
  • NPI Number: 1003238635
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D0900432
LAB Type Physician Office
Facility Name COMMONWEALTH HEALTH PHYSICIAN NETWORK
Street 4 EAST MAIN STREET
City NANTICOKE
State PA
ZIP 18634
Phone 570 258-3939
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/5/2024
Certificate Expiration Date 12/4/2026
Facility Type Physician Office
Lab Director DR. MATTHEW N. KOZICKI

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