33D1092135 CLIA NUMBER - MODERN MEDICAL, PC

Laboratory Demographics

  • CLIA Code: 33D1092135
  • Facility Name: MODERN MEDICAL, PC
  • Facility Address: 225 BROADWAY, SUITE 1420
    NEW YORK, NY
    ZIP 10007
  • Facility Phone: 212 571-5000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ILYA KLEYN, MD
  • NPI Number: 1417057951
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D1092135
LAB Type Physician Office
Facility Name MODERN MEDICAL, PC
Street 225 BROADWAY, SUITE 1420
City NEW YORK
State NY
ZIP 10007
Phone 212 571-5000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2024
Certificate Expiration Date 11/17/2026
Facility Type Physician Office
Lab Director ILYA KLEYN, MD

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