33D0686485 CLIA NUMBER - RUSSELL E RIDER MD

Laboratory Demographics

  • CLIA Code: 33D0686485
  • Facility Name: RUSSELL E RIDER MD
  • Facility Address: 8561 NEWCOMB ROAD
    LONG LAKE, NY
    ZIP 12847
  • Facility Phone: 518 624-2301
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RUSSELL E. RIDER
  • NPI Number: 1245244649
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 33D0686485
LAB Type Physician Office
Facility Name RUSSELL E RIDER MD
Street 8561 NEWCOMB ROAD
City LONG LAKE
State NY
ZIP 12847
Phone 518 624-2301
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director RUSSELL E. RIDER

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