07D0866601 CLIA NUMBER - DERMATOLOGY PHYSICIANS OF CT

Laboratory Demographics

  • CLIA Code: 07D0866601
  • Facility Name: DERMATOLOGY PHYSICIANS OF CT
  • Facility Address: 1 LONG WHARF DRIVE, SUITE 103
    NEW HAVEN, CT
    ZIP 06511
  • Facility Phone: 203 538-5682
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARK J. GOLDSTEIN
  • NPI Number: 1639377690
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 07D0866601
LAB Type Physician Office
Facility Name DERMATOLOGY PHYSICIANS OF CT
Street 1 LONG WHARF DRIVE, SUITE 103
City NEW HAVEN
State CT
ZIP 06511
Phone 203 538-5682
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director MARK J. GOLDSTEIN

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