39D2300395 CLIA NUMBER - JEFFERSON IMAGING CENTER CITY

Laboratory Demographics

  • CLIA Code: 39D2300395
  • Facility Name: JEFFERSON IMAGING CENTER CITY
  • Facility Address: 132 S 10TH ST MAIN BLDG, STE 861 NUC MED
    PHILADELPHIA, PA
    ZIP 19107
  • Facility Phone: 215 955-7871
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. CHARLES M. INTENZO
  • NPI Number: 1700976925
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 39D2300395
LAB Type Physician Office
Facility Name JEFFERSON IMAGING CENTER CITY
Street 132 S 10TH ST MAIN BLDG, STE 861 NUC MED
City PHILADELPHIA
State PA
ZIP 19107
Phone 215 955-7871
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2024
Certificate Expiration Date 3/10/2026
Facility Type Physician Office
Lab Director DR. CHARLES M. INTENZO

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