33D2214376 CLIA NUMBER - CITY MEDICAL OF UPPER EAST SIDE, PLLC

Laboratory Demographics

CLIA Number: 33D2214376

Facility Name: CITY MEDICAL OF UPPER EAST SIDE, PLLC

Facility Address:
6502 18TH AVE
BROOKLYN, NY
ZIP 11204
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Facility Phone Number: 718 571-9423

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1447844758

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2214376
LAB Type	Pharmacy
Facility Name	CITY MEDICAL OF UPPER EAST SIDE, PLLC
Street	6502 18TH AVE
City	BROOKLYN
State	NY
ZIP	11204
Phone	718 571-9423
CertificateType	4
CertificateEffectiveDate	2/22/2021
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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This page was last updated on: 4/23/2024