33D0158094 CLIA NUMBER - OPTUM MEDICAL PC MASSAPEQUA GASTROENTEROLOGY ASSOCIATES

Laboratory Demographics

CLIA Number: 33D0158094

Facility Name: OPTUM MEDICAL PC MASSAPEQUA GASTROENTEROLOGY ASSOCIATES

Facility Address:
850 HICKSVILLE RD SUITE 100
SEAFORD, NY
ZIP 11783
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Facility Phone Number: 516 541-0440

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1568451243

Taxonomy: 207RG0100X - Internal Medicine
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.

CLIA Record

Field Name	Field Value
CLIA Number	33D0158094
LAB Type	Physician Office
Facility Name	OPTUM MEDICAL PC MASSAPEQUA GASTROENTEROLOGY ASSOCIATES
Street	850 HICKSVILLE RD SUITE 100
City	SEAFORD
State	NY
ZIP	11783
Phone	516 541-0440
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