33D1040989 CLIA NUMBER - IMAGE CARE/COMMUNITY CARE PHYSICIANS CAPITAL REGION HEALTH PARK

Laboratory Demographics

  • CLIA Code: 33D1040989
  • Facility Name: IMAGE CARE/COMMUNITY CARE PHYSICIANS CAPITAL REGION HEALTH PARK
  • Facility Address: SUITE G06 6 WELLNESS WAY
    LATHAM, NY
    ZIP 12110
  • Facility Phone: 518 786-1600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MICHAEL R. COOLEY
  • NPI Number: 1538431226
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 33D1040989
LAB Type Physician Office
Facility Name IMAGE CARE/COMMUNITY CARE PHYSICIANS CAPITAL REGION HEALTH PARK
Street SUITE G06 6 WELLNESS WAY
City LATHAM
State NY
ZIP 12110
Phone 518 786-1600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2025
Certificate Expiration Date 5/22/2027
Facility Type Physician Office
Lab Director DR. MICHAEL R. COOLEY

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