33D2183842 CLIA NUMBER - CITY MEDICAL OF UPPER EAST SIDE PLLC

Laboratory Demographics

CLIA Number: 33D2183842

Facility Name: CITY MEDICAL OF UPPER EAST SIDE PLLC

Facility Address:
21 GRAHAM AVE
BROOKLYN, NY
ZIP 11206
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Facility Phone Number: 718 571-9280

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1467071654

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2183842
LAB Type	Physician Office
Facility Name	CITY MEDICAL OF UPPER EAST SIDE PLLC
Street	21 GRAHAM AVE
City	BROOKLYN
State	NY
ZIP	11206
Phone	718 571-9280
CertificateType	4
CertificateEffectiveDate	5/11/2020
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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