33D1075201 CLIA NUMBER - JORDAN B GLASER MD PC

Laboratory Demographics

CLIA Number: 33D1075201

Facility Name: JORDAN B GLASER MD PC

Facility Address:
1408 RICHMOND ROAD
STATEN ISLAND, NY
ZIP 10304
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Facility Phone Number: 718 979-5647

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1821084732

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	33D1075201
LAB Type	Physician Office
Facility Name	JORDAN B GLASER MD PC
Street	1408 RICHMOND ROAD
City	STATEN ISLAND
State	NY
ZIP	10304
Phone	718 979-5647
CertificateType	4
CertificateEffectiveDate	10/16/2023
CertificateExpirationDate	10/15/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024