33D2065725 CLIA NUMBER - GRAND STREET MEDICAL, PLLC

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Laboratory Demographics

CLIA Number: 33D2065725

Facility Name: GRAND STREET MEDICAL, PLLC

Facility Address:
666 GRAND STREET
BROOKLYN, NY
ZIP 11211
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Facility Phone Number: 718 963-0555

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1568485985

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	33D2065725
LAB Type	Physician Office
Facility Name	GRAND STREET MEDICAL, PLLC
Street	666 GRAND STREET
City	BROOKLYN
State	NY
ZIP	11211
Phone	718 963-0555
CertificateType	4
CertificateEffectiveDate	9/13/2023
CertificateExpirationDate	9/12/2025
FacilityType	Waiver

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