33D2153817 CLIA NUMBER - KINGSBRIDGE PHYSICIAN SERVICES INC

Laboratory Demographics

CLIA Number: 33D2153817

Facility Name: KINGSBRIDGE PHYSICIAN SERVICES INC

Facility Address:
5546 BROADWAY
BRONX, NY
ZIP 10463
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Facility Phone Number: 917 688-4590

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1275026635

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2153817
LAB Type	Community Clinic
Facility Name	KINGSBRIDGE PHYSICIAN SERVICES INC
Street	5546 BROADWAY
City	BRONX
State	NY
ZIP	10463
Phone	917 688-4590
CertificateType	4
CertificateEffectiveDate	8/30/2018
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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