33D2205594 CLIA NUMBER - LAKE GROVE SENIOR CENTER, LLC DBATHE BRISTAL AT LAKE GROVE

Laboratory Demographics

  • CLIA Code: 33D2205594
  • Facility Name: LAKE GROVE SENIOR CENTER, LLC DBATHE BRISTAL AT LAKE GROVE
  • Facility Address: 2995 MIDDLE COUNTY ROAD
    LAKE GROVE, NY
    ZIP 11755
  • Facility Phone: 631 676-7580
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: DR. MOHAMMUD M. ALAM
  • NPI Number: 1174075519
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 33D2205594
LAB Type Assisted Living Facility
Facility Name LAKE GROVE SENIOR CENTER, LLC DBATHE BRISTAL AT LAKE GROVE
Street 2995 MIDDLE COUNTY ROAD
City LAKE GROVE
State NY
ZIP 11755
Phone 631 676-7580
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2020
Certificate Expiration Date 3/26/2027
Facility Type Assisted Living Facility
Lab Director DR. MOHAMMUD M. ALAM

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