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33D0157330 CLIA NUMBER - OPTUM MEDICAL PC COLON RECTAL SURGERY- HUNTINGTON

Laboratory Demographics

CLIA Number: 33D0157330

Facility Name: OPTUM MEDICAL PC COLON RECTAL SURGERY- HUNTINGTON

Facility Address:
200 WEST CARVER STREET, #5
HUNTINGTON, NY
ZIP 11743
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Facility Phone Number: 631 423-5070

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1174302871

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name Field Value
CLIA Number 33D0157330
LAB Type Physician Office
Facility Name OPTUM MEDICAL PC COLON RECTAL SURGERY- HUNTINGTON
Street 200 WEST CARVER STREET, #5
City HUNTINGTON
State NY
ZIP 11743
Phone 631 423-5070
CertificateType 4
CertificateEffectiveDate 10/1/2023
CertificateExpirationDate 9/30/2025
FacilityType Waiver

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