33D1079653 CLIA NUMBER - SISSELMAN MEDICAL GROUP - MASSAPEQUA

Laboratory Demographics

  • CLIA Code: 33D1079653
  • Facility Name: SISSELMAN MEDICAL GROUP - MASSAPEQUA
  • Facility Address: 627 BROADWAY - SUITE 1
    MASSAPEQUA, NY
    ZIP 11758
  • Facility Phone: 516 308-4040
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. STEPHEN G. SISSELMAN
  • NPI Number: 1851572358
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 33D1079653
LAB Type Physician Office
Facility Name SISSELMAN MEDICAL GROUP - MASSAPEQUA
Street 627 BROADWAY - SUITE 1
City MASSAPEQUA
State NY
ZIP 11758
Phone 516 308-4040
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/23/2015
Certificate Expiration Date 3/26/2027
Facility Type Physician Office
Lab Director DR. STEPHEN G. SISSELMAN

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This page was last updated on: 3/20/2025