33D0705737 CLIA NUMBER - MALTA FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 33D0705737

Facility Name: MALTA FAMILY MEDICINE

Facility Address:
6 MEDICAL PARK DRIVE, SUITE 208
MALTA, NY
ZIP 12020
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Facility Phone Number: 518 899-2632

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1962527630

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D0705737
LAB Type	Physician Office
Facility Name	MALTA FAMILY MEDICINE
Street	6 MEDICAL PARK DRIVE, SUITE 208
City	MALTA
State	NY
ZIP	12020
Phone	518 899-2632
CertificateType	4
CertificateEffectiveDate	5/13/2024
CertificateExpirationDate	5/12/2026
FacilityType	Waiver

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