33D2211342 CLIA NUMBER - SUGANTHI RAVINDRAN PHYSICIAN PC

Laboratory Demographics

  • CLIA Code: 33D2211342
  • Facility Name: SUGANTHI RAVINDRAN PHYSICIAN PC
  • Facility Address: 709 HAWKINS AVENUE SUITE 1
    LAKE RONKONKOMA, NY
    ZIP 11779
  • Facility Phone: 631 588-0880
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. SUGANTHI RAVIDRAN
  • NPI Number: 1578659819
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 33D2211342
LAB Type Physician Office
Facility Name SUGANTHI RAVINDRAN PHYSICIAN PC
Street 709 HAWKINS AVENUE SUITE 1
City LAKE RONKONKOMA
State NY
ZIP 11779
Phone 631 588-0880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/27/2025
Certificate Expiration Date 1/26/2027
Facility Type Physician Office
Lab Director DR. SUGANTHI RAVIDRAN

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This page was last updated on: 6/4/2025