33D0154159 CLIA NUMBER - LONG BEACH FAMILY MEDICINE PC

Laboratory Demographics

CLIA Number: 33D0154159

Facility Name: LONG BEACH FAMILY MEDICINE PC

Facility Address:
10 FRANKLIN BOULEVARD, SUITE 102
LONG BEACH, NY
ZIP 11561
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Facility Phone Number: 516 889-0100

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1629299516

Taxonomy: 207QA0505X - Family Medicine
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.

CLIA Record

Field Name	Field Value
CLIA Number	33D0154159
LAB Type	Physician Office
Facility Name	LONG BEACH FAMILY MEDICINE PC
Street	10 FRANKLIN BOULEVARD, SUITE 102
City	LONG BEACH
State	NY
ZIP	11561
Phone	516 889-0100
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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