33D2183625 CLIA NUMBER - ITAV-NURSE PRACTITIONER FAMILY HEALTH

Laboratory Demographics

CLIA Number: 33D2183625

Facility Name: ITAV-NURSE PRACTITIONER FAMILY HEALTH

Facility Address:
455 ALBANY AVENUE - UNIT C
AMITYVILLE, NY
ZIP 11701
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Facility Phone Number: 631 532-5093

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1588205025

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	33D2183625
LAB Type	Physician Office
Facility Name	ITAV-NURSE PRACTITIONER FAMILY HEALTH
Street	455 ALBANY AVENUE - UNIT C
City	AMITYVILLE
State	NY
ZIP	11701
Phone	631 532-5093
CertificateType	4
CertificateEffectiveDate	5/7/2024
CertificateExpirationDate	5/6/2026
FacilityType	Waiver

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