33D2018491 CLIA NUMBER - SOUTH SHORE FAMILY MEDICAL ASSOCIATE, PC

Laboratory Demographics

  • CLIA Code: 33D2018491
  • Facility Name: SOUTH SHORE FAMILY MEDICAL ASSOCIATE, PC
  • Facility Address: 787 WEST MERRICK ROAD
    VALLEY STREAM, NY
    ZIP 11580
  • Facility Phone: 718 723-5010
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ALLAN S. DETWEILER
  • NPI Number: 1659536985
  • Taxonomy: 247100000X - Radiologic Technologist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 33D2018491
LAB Type Physician Office
Facility Name SOUTH SHORE FAMILY MEDICAL ASSOCIATE, PC
Street 787 WEST MERRICK ROAD
City VALLEY STREAM
State NY
ZIP 11580
Phone 718 723-5010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/7/2025
Certificate Expiration Date 1/6/2027
Facility Type Physician Office
Lab Director DR. ALLAN S. DETWEILER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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