33D1039926 CLIA NUMBER - FORT WASHINGTON MEDICAL OFFICE

Laboratory Demographics

  • CLIA Code: 33D1039926
  • Facility Name: FORT WASHINGTON MEDICAL OFFICE
  • Facility Address: 65 FORT WASHINGTON AVENUE, APT 1A
    NEW YORK, NY
    ZIP 10032
  • Facility Phone: 212 927-0013
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. FAUSTO A. GONZALEZ
  • NPI Number: 1750685798
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 33D1039926
LAB Type Physician Office
Facility Name FORT WASHINGTON MEDICAL OFFICE
Street 65 FORT WASHINGTON AVENUE, APT 1A
City NEW YORK
State NY
ZIP 10032
Phone 212 927-0013
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/3/2024
Certificate Expiration Date 1/2/2026
Facility Type Physician Office
Lab Director DR. FAUSTO A. GONZALEZ

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