39D1019504 CLIA NUMBER - PENNCARE ADOLESCENT & YOUNG ADULT ASSOC

Laboratory Demographics

  • CLIA Code: 39D1019504
  • Facility Name: PENNCARE ADOLESCENT & YOUNG ADULT ASSOC
  • Facility Address: 145 KING OF PRUSSIA ROAD, 301 NORTH
    RADNOR, PA
    ZIP 19087
  • Facility Phone: 610 902-2450
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. JANICE K. HILLMAN
  • NPI Number: 1336701358
  • Taxonomy: 341600000X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 39D1019504
LAB Type Physician Office
Facility Name PENNCARE ADOLESCENT & YOUNG ADULT ASSOC
Street 145 KING OF PRUSSIA ROAD, 301 NORTH
City RADNOR
State PA
ZIP 19087
Phone 610 902-2450
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/25/2025
Certificate Expiration Date 5/24/2027
Facility Type Physician Office
Lab Director DR. JANICE K. HILLMAN

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