33D2117589 CLIA NUMBER - ORTHOPAEDICS SPINE AND SPORTS MEDICINE LLC

Laboratory Demographics

CLIA Number: 33D2117589

Facility Name: ORTHOPAEDICS SPINE AND SPORTS MEDICINE LLC

Facility Address:
2103 DEER PARK AVE
DEER PARK, NY
ZIP 11729
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Facility Phone Number: 855 321-6784

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1073096590

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	33D2117589
LAB Type	Physician Office
Facility Name	ORTHOPAEDICS SPINE AND SPORTS MEDICINE LLC
Street	2103 DEER PARK AVE
City	DEER PARK
State	NY
ZIP	11729
Phone	855 321-6784
CertificateType	4
CertificateEffectiveDate	8/19/2016
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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