33D0973243 CLIA NUMBER - IRONDEQUOIT INTERNAL MEDICINE LLC

Laboratory Demographics

  • CLIA Code: 33D0973243
  • Facility Name: IRONDEQUOIT INTERNAL MEDICINE LLC
  • Facility Address: 485 TITUS AVENUE, SUITE H
    ROCHESTER, NY
    ZIP 14617
  • Facility Phone: 585 338-2530
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LARISA KHISHCHENKO
  • NPI Number: 1245375708
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 33D0973243
LAB Type Physician Office
Facility Name IRONDEQUOIT INTERNAL MEDICINE LLC
Street 485 TITUS AVENUE, SUITE H
City ROCHESTER
State NY
ZIP 14617
Phone 585 338-2530
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/1/2024
Certificate Expiration Date 4/30/2026
Facility Type Physician Office
Lab Director LARISA KHISHCHENKO

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