33D2155457 CLIA NUMBER - OUTREACH DEVELOPMENT CORP

Laboratory Demographics

  • CLIA Code: 33D2155457
  • Facility Name: OUTREACH DEVELOPMENT CORP
  • Facility Address: 117-11 MYRTLE AVE
    RICHMOND HILL, NY
    ZIP 11418
  • Facility Phone: 631 847-9233
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: DR. ENOCH CHAN
  • NPI Number: 1801564125
  • Taxonomy: 101YA0400X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 33D2155457
LAB Type Comp. Outpatient Rehab Facility
Facility Name OUTREACH DEVELOPMENT CORP
Street 117-11 MYRTLE AVE
City RICHMOND HILL
State NY
ZIP 11418
Phone 631 847-9233
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2018
Certificate Expiration Date 3/26/2027
Facility Type Comp. Outpatient Rehab Facility
Lab Director DR. ENOCH CHAN

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