33D0166138 CLIA NUMBER - MADISON IRVING PEDIATRICS, PC EAST SIDE PEDIATRICS

Laboratory Demographics

CLIA Number: 33D0166138

Facility Name: MADISON IRVING PEDIATRICS, PC EAST SIDE PEDIATRICS

Facility Address:
5900 N BURDICK ST STE 215
EAST SYRACUSE, NY
ZIP 13057
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Facility Phone Number: 315 471-2646

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1063576312

Taxonomy: 2080A0000X - Pediatrics
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

CLIA Record

Field Name	Field Value
CLIA Number	33D0166138
LAB Type	Physician Office
Facility Name	MADISON IRVING PEDIATRICS, PC EAST SIDE PEDIATRICS
Street	5900 N BURDICK ST STE 215
City	EAST SYRACUSE
State	NY
ZIP	13057
Phone	315 471-2646
CertificateType	4
CertificateEffectiveDate	2/18/2023
CertificateExpirationDate	2/17/2025
FacilityType	Waiver

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