33D2113968 CLIA NUMBER - DISTINGUISHED DIAGNOSTIC IMAGING, PC

Laboratory Demographics

CLIA Number: 33D2113968

Facility Name: DISTINGUISHED DIAGNOSTIC IMAGING, PC

Facility Address:
1484 WILLIAMSBRIDGE ROAD
BRONX, NY
ZIP 10461
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Facility Phone Number: 718 828-6800

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1306061890

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2113968
LAB Type	Physician Office
Facility Name	DISTINGUISHED DIAGNOSTIC IMAGING, PC
Street	1484 WILLIAMSBRIDGE ROAD
City	BRONX
State	NY
ZIP	10461
Phone	718 828-6800
CertificateType	4
CertificateEffectiveDate	6/3/2022
CertificateExpirationDate	6/2/2024
FacilityType	Waiver

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