33D0688346 CLIA NUMBER - STANFORD N SULLUM MD

Laboratory Demographics

  • CLIA Code: 33D0688346
  • Facility Name: STANFORD N SULLUM MD
  • Facility Address: 1136 FIFTH AVE
    NEW YORK, NY
    ZIP 10128
  • Facility Phone: 212 876-4630
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: S N SULLUM MD
  • NPI Number: 1477660165
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 33D0688346
LAB Type Physician Office
Facility Name STANFORD N SULLUM MD
Street 1136 FIFTH AVE
City NEW YORK
State NY
ZIP 10128
Phone 212 876-4630
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 S N SULLUM MD

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