33D2002115 CLIA NUMBER - MEDICAL DIAGNOSTIC IMAGING, PLLC

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Laboratory Demographics

CLIA Number: 33D2002115

Facility Name: MEDICAL DIAGNOSTIC IMAGING, PLLC

Facility Address:
14 RAYMOND AVENUE
POUGHKEEPSIE, NY
ZIP 12603
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Facility Phone Number: 845 471-2848

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1760435291

Taxonomy: 261QR0200X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	1/7/2024
CertificateExpirationDate	1/6/2026
FacilityType	Waiver

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