33D0158777 CLIA NUMBER - MARK DI BENEDETTO MD

Laboratory Demographics

  • CLIA Code: 33D0158777
  • Facility Name: MARK DI BENEDETTO MD
  • Facility Address: 710 MAIN
    PORT JEFFERSON, NY
    ZIP 11777
  • Facility Phone: 631 474-4000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARK J. DIBENEDETTO
  • NPI Number: 1619940269
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 33D0158777
LAB Type Physician Office
Facility Name MARK DI BENEDETTO MD
Street 710 MAIN
City PORT JEFFERSON
State NY
ZIP 11777
Phone 631 474-4000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/21/2024
Certificate Expiration Date 1/20/2026
Facility Type Physician Office
Lab Director MARK J. DIBENEDETTO

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