33D2011030 CLIA NUMBER - GRAND CONCOURSE MEDICAL PRACTICE

Laboratory Demographics

  • CLIA Code: 33D2011030
  • Facility Name: GRAND CONCOURSE MEDICAL PRACTICE
  • Facility Address: 1831 GRAND CONCOURSE SUITE A
    BRONX, NY
    ZIP 10453
  • Facility Phone: 347 377-5804
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MANUEL E. MEJIA
  • NPI Number: 1265744197
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 33D2011030
LAB Type Physician Office
Facility Name GRAND CONCOURSE MEDICAL PRACTICE
Street 1831 GRAND CONCOURSE SUITE A
City BRONX
State NY
ZIP 10453
Phone 347 377-5804
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2024
Certificate Expiration Date 8/9/2026
Facility Type Physician Office
Lab Director DR. MANUEL E. MEJIA

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