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33D2012193 CLIA NUMBER - PORT JERVIS CBOC

Laboratory Demographics

CLIA Number: 33D2012193

Facility Name: PORT JERVIS CBOC

Facility Address:
150 PIKE STREET
PORT JERVIS, NY
ZIP 12771
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Facility Phone Number: 845 856-5346

Facility Type: Community Clinic

Certificate Type: Accreditation
NPI Number: 1093864316

Taxonomy: 251300000X - Local Education Agency (LEA)
The term local education agency means a public board of education or other public authority legally constituted within a State to either provide administrative control or direction of, or perform a service function for public schools serving individuals ages 0 - 21 in a state, city, county, township, school district, or other political subdivision including a combination of school districts or counties recognized in a State as an administrative agency for its public schools. An LEA may provide, or employ professional who provide, services to children included in the Individuals with Disabilities Education Act (IDEA), such services may include, but are not limited to, such medical services as physical, occupational, and speech therapy.

CLIA Record

Field Name Field Value
CLIA Number 33D2012193
LAB Type Community Clinic
Facility Name PORT JERVIS CBOC
Street 150 PIKE STREET
City PORT JERVIS
State NY
ZIP 12771
Phone 845 856-5346
CertificateType 1
CertificateEffectiveDate 7/15/2014
CertificateExpirationDate 5/22/2026
FacilityType Accreditation

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