39D1084774 CLIA NUMBER - JEFFERSON PEDIATRICS - PENNYPACK

Laboratory Demographics

  • CLIA Code: 39D1084774
  • Facility Name: JEFFERSON PEDIATRICS - PENNYPACK
  • Facility Address: 8556 BUSTLETON AVENUE
    PHILADELPHIA, PA
    ZIP 19152
  • Facility Phone: 215 331-1516
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. DIPANWITA ROY
  • NPI Number: 1730571324
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D1084774
LAB Type Physician Office
Facility Name JEFFERSON PEDIATRICS - PENNYPACK
Street 8556 BUSTLETON AVENUE
City PHILADELPHIA
State PA
ZIP 19152
Phone 215 331-1516
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/4/2024
Certificate Expiration Date 6/3/2026
Facility Type Physician Office
Lab Director DR. DIPANWITA ROY

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