33D0695091 CLIA NUMBER - PEDIATRIC AND ADOLESCENT HEALTH MD PC

Laboratory Demographics

  • CLIA Code: 33D0695091
  • Facility Name: PEDIATRIC AND ADOLESCENT HEALTH MD PC
  • Facility Address: 639 MAIN STREET
    JOHNSON CITY, NY
    ZIP 13790
  • Facility Phone: 607 770-1988
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: J ROGER CHATTERTON
  • NPI Number: 1619923752
  • Taxonomy: 2080A0000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 33D0695091
LAB Type Physician Office
Facility Name PEDIATRIC AND ADOLESCENT HEALTH MD PC
Street 639 MAIN STREET
City JOHNSON CITY
State NY
ZIP 13790
Phone 607 770-1988
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 J ROGER CHATTERTON

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This page was last updated on: 6/4/2025