39D2116825 CLIA NUMBER - TEMPLE INTERNAL MEDICINE NORTHEAST

Laboratory Demographics

  • CLIA Code: 39D2116825
  • Facility Name: TEMPLE INTERNAL MEDICINE NORTHEAST
  • Facility Address: 9892 BUSTLETON AVE, SUITE 101
    PHILADELPHIA, PA
    ZIP 19115
  • Facility Phone: 215 676-2741
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MIKHAIL I. AZRILEVICH
  • NPI Number: 1205245040
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D2116825
LAB Type Physician Office
Facility Name TEMPLE INTERNAL MEDICINE NORTHEAST
Street 9892 BUSTLETON AVE, SUITE 101
City PHILADELPHIA
State PA
ZIP 19115
Phone 215 676-2741
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/31/2025
Certificate Expiration Date 5/30/2027
Facility Type Physician Office
Lab Director DR. MIKHAIL I. AZRILEVICH

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