33D2144716 CLIA NUMBER - DIVINITY MEDICAL SERVICES PLLC

Laboratory Demographics

  • CLIA Code: 33D2144716
  • Facility Name: DIVINITY MEDICAL SERVICES PLLC
  • Facility Address: 1210 WEBSTER AVE
    BRONX, NY
    ZIP 10456
  • Facility Phone: 646 627-7747
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: DR. RAJESH GUPTA
  • NPI Number: 1316511488
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D2144716
LAB Type Community Clinic
Facility Name DIVINITY MEDICAL SERVICES PLLC
Street 1210 WEBSTER AVE
City BRONX
State NY
ZIP 10456
Phone 646 627-7747
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/22/2018
Certificate Expiration Date 3/26/2027
Facility Type Community Clinic
Lab Director DR. RAJESH GUPTA

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This page was last updated on: 6/4/2025