33D2004938 CLIA NUMBER - WOODSIDE MEDICAL PRACTICE PC

Laboratory Demographics

  • CLIA Code: 33D2004938
  • Facility Name: WOODSIDE MEDICAL PRACTICE PC
  • Facility Address: 53-14 ROOSEVELT AVENUE, 3RD FLOOR, SUITE 300
    WOODSIDE, NY
    ZIP 11377
  • Facility Phone: 718 606-2682
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. RAFAEL RODRIGUEZ
  • NPI Number: 1356677876
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 33D2004938
LAB Type Physician Office
Facility Name WOODSIDE MEDICAL PRACTICE PC
Street 53-14 ROOSEVELT AVENUE, 3RD FLOOR, SUITE 300
City WOODSIDE
State NY
ZIP 11377
Phone 718 606-2682
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2024
Certificate Expiration Date 3/15/2026
Facility Type Physician Office
Lab Director DR. RAFAEL RODRIGUEZ

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