33D2080193 CLIA NUMBER - AVICENNA AMBULATORY SURGERY CENTER

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Laboratory Demographics

CLIA Number: 33D2080193

Facility Name: AVICENNA AMBULATORY SURGERY CENTER

Facility Address:
2522 HUGHES AVENUE
BRONX, NY
ZIP 10458
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Facility Phone Number: 718 933-1918

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1619398542

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2080193
LAB Type	Ambulatory Surgery Center
Facility Name	AVICENNA AMBULATORY SURGERY CENTER
Street	2522 HUGHES AVENUE
City	BRONX
State	NY
ZIP	10458
Phone	718 933-1918
CertificateType	4
CertificateEffectiveDate	7/2/2014
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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