33D1021077 CLIA NUMBER - MICHAEL G MARCUS, MD

Laboratory Demographics

CLIA Number: 33D1021077

Facility Name: MICHAEL G MARCUS, MD

Facility Address:
105 BENTON AVENUE
STATEN ISLAND, NY
ZIP 10305
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Facility Phone Number: 718 980-5864

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1962084343

Taxonomy: 390200000X - Student in an Organized Health Care Education/Training Program
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

CLIA Record

Field Name	Field Value
CLIA Number	33D1021077
LAB Type	Physician Office
Facility Name	MICHAEL G MARCUS, MD
Street	105 BENTON AVENUE
City	STATEN ISLAND
State	NY
ZIP	10305
Phone	718 980-5864
CertificateType	4
CertificateEffectiveDate	10/20/2023
CertificateExpirationDate	10/19/2025
FacilityType	Waiver

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