33D2193038 CLIA NUMBER - KATHLEEN VINE MD PC DBA AMANGANSETT DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 33D2193038
  • Facility Name: KATHLEEN VINE MD PC DBA AMANGANSETT DERMATOLOGY
  • Facility Address: 524 MONTAUK HIGHWAY - STE 101
    AMAGANSETT, NY
    ZIP 11930
  • Facility Phone: (646) 421-6064
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. ANNE C. HARDICK-DACKO
  • NPI Number: 1659534410
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 33D2193038
LAB Type Physician Office
Facility Name KATHLEEN VINE MD PC DBA AMANGANSETT DERMATOLOGY
Street 524 MONTAUK HIGHWAY - STE 101
City AMAGANSETT
State NY
ZIP 11930
Phone 6464216064
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 9/16/2024
Certificate Expiration Date 9/15/2026
Facility Type Physician Office
Lab Director DR. ANNE C. HARDICK-DACKO

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This page was last updated on: 5/18/2026