33D2192460 CLIA NUMBER - HUDSON HEADWATERS PEDIATRIC AND ADOLESCENT HEALTH

Laboratory Demographics

  • CLIA Code: 33D2192460
  • Facility Name: HUDSON HEADWATERS PEDIATRIC AND ADOLESCENT HEALTH
  • Facility Address: 28 S WESTERN AVE
    QUEENSBURY, NY
    ZIP 12804
  • Facility Phone: 518 798-6400
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: DR. THOMAS G. PORTUESE
  • NPI Number: 1386657534
  • Taxonomy: 261QP2300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 33D2192460
LAB Type Federally Qualified Health Center
Facility Name HUDSON HEADWATERS PEDIATRIC AND ADOLESCENT HEALTH
Street 28 S WESTERN AVE
City QUEENSBURY
State NY
ZIP 12804
Phone 518 798-6400
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/10/2020
Certificate Expiration Date 3/26/2027
Facility Type Federally Qualified Health Center
Lab Director DR. THOMAS G. PORTUESE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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