33D1098073 CLIA NUMBER - FAMILY MEDICINE OF MECHANICVILLE PLLC

Laboratory Demographics

CLIA Number: 33D1098073

Facility Name: FAMILY MEDICINE OF MECHANICVILLE PLLC

Facility Address:
242 SOUTH CENTRAL AVENUE
MECHANICVILLE, NY
ZIP 12118
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Facility Phone Number: 518 664-4185

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1487898425

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D1098073
LAB Type	Physician Office
Facility Name	FAMILY MEDICINE OF MECHANICVILLE PLLC
Street	242 SOUTH CENTRAL AVENUE
City	MECHANICVILLE
State	NY
ZIP	12118
Phone	518 664-4185
CertificateType	3
CertificateEffectiveDate	4/10/2023
CertificateExpirationDate	4/9/2025
FacilityType	PPMP

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