33D0709329 CLIA NUMBER - EVERETT FORMAN PC

Laboratory Demographics

  • CLIA Code: 33D0709329
  • Facility Name: EVERETT FORMAN PC
  • Facility Address: 585 TROY-SCHENECTADY ROAD
    LATHAM, NY
    ZIP 12110
  • Facility Phone: 518 785-6004
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: EVERETT R. FORMAN MD
  • NPI Number: 1528061967
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 33D0709329
LAB Type Physician Office
Facility Name EVERETT FORMAN PC
Street 585 TROY-SCHENECTADY ROAD
City LATHAM
State NY
ZIP 12110
Phone 518 785-6004
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 7/23/2025
Certificate Expiration Date 7/22/2027
Facility Type Physician Office
Lab Director EVERETT R. FORMAN MD

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