33D0877274 CLIA NUMBER - IRVING GOLDMAN FAMILY CARE CENTER

Laboratory Demographics

CLIA Code: 33D0877274
Facility Name: IRVING GOLDMAN FAMILY CARE CENTER
Facility Address: 865 NORTHERN BLVD
GREAT NECK, NY
ZIP 11021
Facility Phone: 516 562-4057
Facility Type: Ancillary Testing Site in Health Care Center
Facility Type: Microscopy
Lab Director: DR. TYLIS Y. CHANG
NPI Number: 1184843062
Taxonomy: 1223P0700X - Dentist

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CLIA Record

Field Name	Field Value
CLIA Number	33D0877274
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	IRVING GOLDMAN FAMILY CARE CENTER
Street	865 NORTHERN BLVD
City	GREAT NECK
State	NY
ZIP	11021
Phone	516 562-4057
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	5/15/2006
Certificate Expiration Date	3/26/2027
Facility Type	Ancillary Testing Site in Health Care Center
Lab Director	DR. TYLIS Y. CHANG

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