33D0891472 CLIA NUMBER - FIVE TOWNS MEDICINE AND CARDIOLOGY

Laboratory Demographics

CLIA Number: 33D0891472

Facility Name: FIVE TOWNS MEDICINE AND CARDIOLOGY

Facility Address:
123 MAPLE AVENUE, SUITE 202
CEDARHURST, NY
ZIP 11516
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Facility Phone Number: 516 374-6363

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1992243018

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	33D0891472
LAB Type	Physician Office
Facility Name	FIVE TOWNS MEDICINE AND CARDIOLOGY
Street	123 MAPLE AVENUE, SUITE 202
City	CEDARHURST
State	NY
ZIP	11516
Phone	516 374-6363
CertificateType	4
CertificateEffectiveDate	8/27/2023
CertificateExpirationDate	8/26/2025
FacilityType	Waiver

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