07D2320774 CLIA NUMBER - REVERSE TIME WELLNESS INC

Laboratory Demographics

  • CLIA Code: 07D2320774
  • Facility Name: REVERSE TIME WELLNESS INC
  • Facility Address: 1086 LONG RIDGE RD
    STAMFORD, CT
    ZIP 06903
  • Facility Phone: 917 773-5270
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: NEISHELLE WALCOTT
  • NPI Number: 1003611187
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 07D2320774
LAB Type Practitioner Other
Facility Name REVERSE TIME WELLNESS INC
Street 1086 LONG RIDGE RD
City STAMFORD
State CT
ZIP 06903
Phone 917 773-5270
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2025
Certificate Expiration Date 3/23/2027
Facility Type Practitioner Other
Lab Director NEISHELLE WALCOTT

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