33D1038601 CLIA NUMBER - OPTUM MEDICAL CARE PC

Laboratory Demographics

  • CLIA Code: 33D1038601
  • Facility Name: OPTUM MEDICAL CARE PC
  • Facility Address: 1500 ROUTE 112, BUILDING 1, SUITE 201
    PORT JEFFERSON STATION, NY
    ZIP 11776
  • Facility Phone: 631 732-9090
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JOSEPH K. CAVALLO
  • NPI Number: 1518173897
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 33D1038601
LAB Type Physician Office
Facility Name OPTUM MEDICAL CARE PC
Street 1500 ROUTE 112, BUILDING 1, SUITE 201
City PORT JEFFERSON STATION
State NY
ZIP 11776
Phone 631 732-9090
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/23/2024
Certificate Expiration Date 12/22/2026
Facility Type Physician Office
Lab Director DR. JOSEPH K. CAVALLO

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