07D2149140 CLIA NUMBER - AVANTA CLINIC LLC

Laboratory Demographics

  • CLIA Code: 07D2149140
  • Facility Name: AVANTA CLINIC LLC
  • Facility Address: 131 NEW LONDON TPKE, STE 105
    GLASTONBURY, CT
    ZIP 06033
  • Facility Phone: 860 430-5599
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUDEEP BANSAL
  • NPI Number: 1619467826
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 07D2149140
LAB Type Physician Office
Facility Name AVANTA CLINIC LLC
Street 131 NEW LONDON TPKE, STE 105
City GLASTONBURY
State CT
ZIP 06033
Phone 860 430-5599
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/25/2024
Certificate Expiration Date 5/24/2026
Facility Type Physician Office
Lab Director SUDEEP BANSAL

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