33D0998757 CLIA NUMBER - KOINONIA PRIMARY CARE INC

Laboratory Demographics

CLIA Number: 33D0998757

Facility Name: KOINONIA PRIMARY CARE INC

Facility Address:
553 CLINTON AVENUE
ALBANY, NY
ZIP 12206
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Facility Phone Number: 518 689-0282

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1225122054

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D0998757
LAB Type	Community Clinic
Facility Name	KOINONIA PRIMARY CARE INC
Street	553 CLINTON AVENUE
City	ALBANY
State	NY
ZIP	12206
Phone	518 689-0282
CertificateType	4
CertificateEffectiveDate	3/27/2018
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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