33D0173031 CLIA NUMBER - SOUTHEAST OBSTETRICS AND GYNECOLOGY PC

Laboratory Demographics

  • CLIA Code: 33D0173031
  • Facility Name: SOUTHEAST OBSTETRICS AND GYNECOLOGY PC
  • Facility Address: 990 SOUTH AVE STE 104
    ROCHESTER, NY
    ZIP 14620
  • Facility Phone: 585 256-3000
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: RAPHAEL T. TSHIBANGU MD
  • NPI Number: 1184764524
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 33D0173031
LAB Type Physician Office
Facility Name SOUTHEAST OBSTETRICS AND GYNECOLOGY PC
Street 990 SOUTH AVE STE 104
City ROCHESTER
State NY
ZIP 14620
Phone 585 256-3000
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director RAPHAEL T. TSHIBANGU MD

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