33D2040110 CLIA NUMBER - CITY MEDICAL OF UPPER EAST SIDE PLLC

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Laboratory Demographics

CLIA Number: 33D2040110

Facility Name: CITY MEDICAL OF UPPER EAST SIDE PLLC

Facility Address:
418-420 5TH AVENUE
BROOKLYN, NY
ZIP 11215
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Facility Phone Number: 718 965-2273

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1609148733

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2040110
LAB Type	Physician Office
Facility Name	CITY MEDICAL OF UPPER EAST SIDE PLLC
Street	418-420 5TH AVENUE
City	BROOKLYN
State	NY
ZIP	11215
Phone	718 965-2273
CertificateType	4
CertificateEffectiveDate	5/31/2019
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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