33D2182292 CLIA NUMBER - INTEGRATED INTERVENTIONAL PAIN MANAGEMENT PC

Laboratory Demographics

CLIA Number: 33D2182292

Facility Name: INTEGRATED INTERVENTIONAL PAIN MANAGEMENT PC

Facility Address:
207-12 NORTHERN BLVD 3RD FLOOR
BAYSIDE, NY
ZIP 11361
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Facility Phone Number: 718 307-9905

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1164918835

Taxonomy: 261QP3300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2182292
LAB Type	Physician Office
Facility Name	INTEGRATED INTERVENTIONAL PAIN MANAGEMENT PC
Street	207-12 NORTHERN BLVD 3RD FLOOR
City	BAYSIDE
State	NY
ZIP	11361
Phone	718 307-9905
CertificateType	4
CertificateEffectiveDate	4/20/2024
CertificateExpirationDate	4/19/2026
FacilityType	Waiver

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