33D1008791 CLIA NUMBER - BOSTON ROAD MEDICAL PRACTICE PC

Laboratory Demographics

  • CLIA Code: 33D1008791
  • Facility Name: BOSTON ROAD MEDICAL PRACTICE PC
  • Facility Address: 2190 BOSTON RD SUITE 1N
    BRONX, NY
    ZIP 10462
  • Facility Phone: 718 863-8663
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: VALERI I. KAZAKOV
  • NPI Number: 1306816285
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 33D1008791
LAB Type Physician Office
Facility Name BOSTON ROAD MEDICAL PRACTICE PC
Street 2190 BOSTON RD SUITE 1N
City BRONX
State NY
ZIP 10462
Phone 718 863-8663
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 1/28/2025
Certificate Expiration Date 1/27/2027
Facility Type Physician Office
Lab Director VALERI I. KAZAKOV

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