33D2110426 CLIA NUMBER - PORT JEFFERSON MEDICINE PC

Laboratory Demographics

  • CLIA Code: 33D2110426
  • Facility Name: PORT JEFFERSON MEDICINE PC
  • Facility Address: 2 MEDICAL DRIVE - SUITE D
    PORT JEFFERSON STATION, NY
    ZIP 11776
  • Facility Phone: 631 331-5010
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. DEEPTI GUPTA
  • NPI Number: 1346770484
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 33D2110426
LAB Type Physician Office
Facility Name PORT JEFFERSON MEDICINE PC
Street 2 MEDICAL DRIVE - SUITE D
City PORT JEFFERSON STATION
State NY
ZIP 11776
Phone 631 331-5010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/15/2016
Certificate Expiration Date 3/26/2027
Facility Type Physician Office
Lab Director DR. DEEPTI GUPTA

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