33D1069476 CLIA NUMBER - PRIDE MEDICAL PLLC

Laboratory Demographics

  • CLIA Code: 33D1069476
  • Facility Name: PRIDE MEDICAL PLLC
  • Facility Address: 3875 BROADWAY, UNIT B
    NEW YORK, NY
    ZIP 10032
  • Facility Phone: 212 543-3110
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. PUNYADECH PHOTANGTHAM
  • NPI Number: 1922214600
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D1069476
LAB Type Physician Office
Facility Name PRIDE MEDICAL PLLC
Street 3875 BROADWAY, UNIT B
City NEW YORK
State NY
ZIP 10032
Phone 212 543-3110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/6/2025
Certificate Expiration Date 6/5/2027
Facility Type Physician Office
Lab Director DR. PUNYADECH PHOTANGTHAM

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