33D2190283 CLIA NUMBER - WESTSIDE FAMILY MEDICINE PLLC

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Laboratory Demographics

CLIA Number: 33D2190283

Facility Name: WESTSIDE FAMILY MEDICINE PLLC

Facility Address:
55 EAST 87TH ST SUITE 1F
NEW YORK, NY
ZIP 10128
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Facility Phone Number: 917 258-2142

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1477865558

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	33D2190283
LAB Type	Physician Office
Facility Name	WESTSIDE FAMILY MEDICINE PLLC
Street	55 EAST 87TH ST SUITE 1F
City	NEW YORK
State	NY
ZIP	10128
Phone	917 258-2142
CertificateType	4
CertificateEffectiveDate	8/12/2022
CertificateExpirationDate	8/11/2024
FacilityType	Waiver

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