33D2115614 CLIA NUMBER - REVITALIZE CNY LLC

Laboratory Demographics

  • CLIA Code: 33D2115614
  • Facility Name: REVITALIZE CNY LLC
  • Facility Address: 6800 E GENESEE ST - SUITE 1200
    FAYETTEVILLE, NY
    ZIP 13066
  • Facility Phone: 315 251-1234
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: DR. THERESA M. SETTER
  • NPI Number: 1396103438
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D2115614
LAB Type Independent
Facility Name REVITALIZE CNY LLC
Street 6800 E GENESEE ST - SUITE 1200
City FAYETTEVILLE
State NY
ZIP 13066
Phone 315 251-1234
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2022
Certificate Expiration Date 3/26/2027
Facility Type Independent
Lab Director DR. THERESA M. SETTER

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