33D2002115 CLIA NUMBER - MEDICAL DIAGNOSTIC IMAGING, PLLC

Laboratory Demographics

  • CLIA Code: 33D2002115
  • Facility Name: MEDICAL DIAGNOSTIC IMAGING, PLLC
  • Facility Address: 14 RAYMOND AVENUE
    POUGHKEEPSIE, NY
    ZIP 12603
  • Facility Phone: 845 471-2848
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. GARY D. GROSSMAN
  • NPI Number: 1760435291
  • Taxonomy: 261QR0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D2002115
LAB Type Physician Office
Facility Name MEDICAL DIAGNOSTIC IMAGING, PLLC
Street 14 RAYMOND AVENUE
City POUGHKEEPSIE
State NY
ZIP 12603
Phone 845 471-2848
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/7/2024
Certificate Expiration Date 1/6/2026
Facility Type Physician Office
Lab Director DR. GARY D. GROSSMAN

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