33D2116318 CLIA NUMBER - SOUTH SHORE FAMILY MEDICAL ASSOCIATE PC

Laboratory Demographics

CLIA Number: 33D2116318

Facility Name: SOUTH SHORE FAMILY MEDICAL ASSOCIATE PC

Facility Address:
265 WEST PARK AVENUE
LONG BEACH, NY
ZIP 11561
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Facility Phone Number: 516 431-3600

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1053472050

Taxonomy: 207RP1001X - Internal Medicine
An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

CLIA Record

Field Name	Field Value
CLIA Number	33D2116318
LAB Type	Physician Office
Facility Name	SOUTH SHORE FAMILY MEDICAL ASSOCIATE PC
Street	265 WEST PARK AVENUE
City	LONG BEACH
State	NY
ZIP	11561
Phone	516 431-3600
CertificateType	4
CertificateEffectiveDate	7/25/2022
CertificateExpirationDate	7/24/2024
FacilityType	Waiver

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