33D0158843 CLIA NUMBER - NSHOA NEW YORK HEALTH PORT JEFFERSON OBGYN

Laboratory Demographics

  • CLIA Code: 33D0158843
  • Facility Name: NSHOA NEW YORK HEALTH PORT JEFFERSON OBGYN
  • Facility Address: 118 NORTH COUNTRY ROAD
    PORT JEFFERSON, NY
    ZIP 11777
  • Facility Phone: 631 663-4861
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. LANCE H. EDWARDS
  • NPI Number: 1982790192
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 33D0158843
LAB Type Physician Office
Facility Name NSHOA NEW YORK HEALTH PORT JEFFERSON OBGYN
Street 118 NORTH COUNTRY ROAD
City PORT JEFFERSON
State NY
ZIP 11777
Phone 631 663-4861
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/1/2024
Certificate Expiration Date 7/31/2026
Facility Type Physician Office
Lab Director DR. LANCE H. EDWARDS

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