33D1088847 CLIA NUMBER - RICHMOND PRIMARY CARE

Laboratory Demographics

CLIA Number: 33D1088847

Facility Name: RICHMOND PRIMARY CARE

Facility Address:
305 SEGUINE AVENUE SUITE 1
STATEN ISLAND, NY
ZIP 10309
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Facility Phone Number: 718 967-8300

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1013048271

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	33D1088847
LAB Type	Physician Office
Facility Name	RICHMOND PRIMARY CARE
Street	305 SEGUINE AVENUE SUITE 1
City	STATEN ISLAND
State	NY
ZIP	10309
Phone	718 967-8300
CertificateType	4
CertificateEffectiveDate	9/5/2022
CertificateExpirationDate	9/4/2024
FacilityType	Waiver

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