39D2304724 CLIA NUMBER - STEPHEN & SANDRA SHELLER BRIDGE PRGM TJU, THE

Laboratory Demographics

  • CLIA Code: 39D2304724
  • Facility Name: STEPHEN & SANDRA SHELLER BRIDGE PRGM TJU, THE
  • Facility Address: 1015 CHESTNUT ST SUITE 1020
    PHILADELPHIA, PA
    ZIP 19107
  • Facility Phone: 215 955-0030
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: DR. LARA C. WEINSTEIN
  • NPI Number: 1982620035
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 39D2304724
LAB Type Community Clinic
Facility Name STEPHEN & SANDRA SHELLER BRIDGE PRGM TJU, THE
Street 1015 CHESTNUT ST SUITE 1020
City PHILADELPHIA
State PA
ZIP 19107
Phone 215 955-0030
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/17/2024
Certificate Expiration Date 5/16/2026
Facility Type Community Clinic
Lab Director DR. LARA C. WEINSTEIN

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