07D2092087 CLIA NUMBER - GYNECOLOGIC CANCER CARE, LLC

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Laboratory Demographics

CLIA Number: 07D2092087

Facility Name: GYNECOLOGIC CANCER CARE, LLC

Facility Address:
1290 SUMMER ST, SUITE 5200
STAMFORD, CT
ZIP 06905
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Facility Phone Number: 000 203-9980

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1316354079

Taxonomy: 207VX0201X - Obstetrics & Gynecology
An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications.

CLIA Record

Field Name	Field Value
CLIA Number	07D2092087
LAB Type	Physician Office
Facility Name	GYNECOLOGIC CANCER CARE, LLC
Street	1290 SUMMER ST, SUITE 5200
City	STAMFORD
State	CT
ZIP	06905
Phone	000 203-9980
CertificateType	4
CertificateEffectiveDate	2/26/2023
CertificateExpirationDate	2/25/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024