33D2173066 CLIA NUMBER - SOUTHOLD FAMILY MEDICINE A LOCATION OF STONY BROOK FAMILY MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 33D2173066
  • Facility Name: SOUTHOLD FAMILY MEDICINE A LOCATION OF STONY BROOK FAMILY MEDICAL GROUP
  • Facility Address: 44360 COUNTY ROAD 48
    SOUTHOLD, NY
    ZIP 11971
  • Facility Phone: 631 734-8742
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JARID S. PACHTER
  • NPI Number: 1558412213
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 33D2173066
LAB Type Physician Office
Facility Name SOUTHOLD FAMILY MEDICINE A LOCATION OF STONY BROOK FAMILY MEDICAL GROUP
Street 44360 COUNTY ROAD 48
City SOUTHOLD
State NY
ZIP 11971
Phone 631 734-8742
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2019
Certificate Expiration Date 3/26/2027
Facility Type Physician Office
Lab Director DR. JARID S. PACHTER

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