39D2040419 CLIA NUMBER - QUEEN VILLAGE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 39D2040419
  • Facility Name: QUEEN VILLAGE PEDIATRICS
  • Facility Address: 528 S 2ND STREET, SUITE 109
    PHILADELPHIA, PA
    ZIP 19147
  • Facility Phone: 215 592-0715
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JODI M. KEFER MD
  • NPI Number: 1801559125
  • Taxonomy: 1041C0700X - Social Worker

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CLIA Record

Field Name Field Value
CLIA Number 39D2040419
LAB Type Physician Office
Facility Name QUEEN VILLAGE PEDIATRICS
Street 528 S 2ND STREET, SUITE 109
City PHILADELPHIA
State PA
ZIP 19147
Phone 215 592-0715
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/30/2024
Certificate Expiration Date 4/29/2026
Facility Type Physician Office
Lab Director DR. JODI M. KEFER MD

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