33D2188746 CLIA NUMBER - MIDDLE VILLAGE DIAGNOSTIC

Laboratory Demographics

  • CLIA Code: 33D2188746
  • Facility Name: MIDDLE VILLAGE DIAGNOSTIC
  • Facility Address: 62-43 WOODHAVEN BLVD
    REGO PARK, NY
    ZIP 11374
  • Facility Phone: 718 507-4700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. CHARLES J. DEMARCO
  • NPI Number: 1497771687
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 33D2188746
LAB Type Physician Office
Facility Name MIDDLE VILLAGE DIAGNOSTIC
Street 62-43 WOODHAVEN BLVD
City REGO PARK
State NY
ZIP 11374
Phone 718 507-4700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/21/2024
Certificate Expiration Date 7/20/2026
Facility Type Physician Office
Lab Director DR. CHARLES J. DEMARCO

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