33D2006690 CLIA NUMBER - MIMI G BANSAL MD

Laboratory Demographics

  • CLIA Code: 33D2006690
  • Facility Name: MIMI G BANSAL MD
  • Facility Address: 2001 MARCUS AVENUE, SUITE E130
    NEW HYDE PARK, NY
    ZIP 11042
  • Facility Phone: 516 352-2766
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. JIANYOU TAN MD
  • NPI Number: 1568563567
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 33D2006690
LAB Type Physician Office
Facility Name MIMI G BANSAL MD
Street 2001 MARCUS AVENUE, SUITE E130
City NEW HYDE PARK
State NY
ZIP 11042
Phone 516 352-2766
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 5/18/2024
Certificate Expiration Date 5/17/2026
Facility Type Physician Office
Lab Director DR. JIANYOU TAN MD

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