33D2010520 CLIA NUMBER - KINGS PARK MEDICINE PC

Laboratory Demographics

  • CLIA Code: 33D2010520
  • Facility Name: KINGS PARK MEDICINE PC
  • Facility Address: 93 MAIN STREET, SUITE A
    KINGS PARK, NY
    ZIP 11754
  • Facility Phone: 631 292-2725
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. WEYMIN G. HAGO
  • NPI Number: 1275847733
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 33D2010520
LAB Type Physician Office
Facility Name KINGS PARK MEDICINE PC
Street 93 MAIN STREET, SUITE A
City KINGS PARK
State NY
ZIP 11754
Phone 631 292-2725
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/24/2024
Certificate Expiration Date 9/23/2026
Facility Type Physician Office
Lab Director DR. WEYMIN G. HAGO

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