52D1102904 CLIA NUMBER - FOREFRONT DERMATOLOGY, SC

Laboratory Demographics

  • CLIA Code: 52D1102904
  • Facility Name: FOREFRONT DERMATOLOGY, SC
  • Facility Address: 1620 N SHAWANO ST STE C
    NEW LONDON, WI
    ZIP 54961
  • Facility Phone: 920 982-3870
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. PETER J. KATZ
  • NPI Number: 1063641249
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 52D1102904
LAB Type Physician Office
Facility Name FOREFRONT DERMATOLOGY, SC
Street 1620 N SHAWANO ST STE C
City NEW LONDON
State WI
ZIP 54961
Phone 920 982-3870
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/28/2025
Certificate Expiration Date 7/27/2027
Facility Type Physician Office
Lab Director DR. PETER J. KATZ

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