33D2192904 CLIA NUMBER - JERICHO ROAD COMMUNITY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 33D2192904
  • Facility Name: JERICHO ROAD COMMUNITY HEALTH CENTER
  • Facility Address: 1021 BROADWAY STREET
    BUFFALO, NY
    ZIP 14212
  • Facility Phone: 716 529-3030
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: DR. CARLA R. HENKE
  • NPI Number: 1952893091
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D2192904
LAB Type Federally Qualified Health Center
Facility Name JERICHO ROAD COMMUNITY HEALTH CENTER
Street 1021 BROADWAY STREET
City BUFFALO
State NY
ZIP 14212
Phone 716 529-3030
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 9/16/2020
Certificate Expiration Date 3/26/2027
Facility Type Federally Qualified Health Center
Lab Director DR. CARLA R. HENKE

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