33D1024765 CLIA NUMBER - LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY

Laboratory Demographics

  • CLIA Code: 33D1024765
  • Facility Name: LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY
  • Facility Address: 210 CORNELIA STREET SUITE 406
    PLATTSBURGH, NY
    ZIP 12901
  • Facility Phone: 802 859-9500
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. GAMAL H. ELTABBAKH
  • NPI Number: 1164418455
  • Taxonomy: 207VX0201X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 33D1024765
LAB Type Physician Office
Facility Name LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY
Street 210 CORNELIA STREET SUITE 406
City PLATTSBURGH
State NY
ZIP 12901
Phone 802 859-9500
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 4/21/2024
Certificate Expiration Date 4/20/2026
Facility Type Physician Office
Lab Director DR. GAMAL H. ELTABBAKH

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