33D2225039 CLIA NUMBER - COSMETIC SURGERY OF NEW YORK PC

Laboratory Demographics

CLIA Number: 33D2225039

Facility Name: COSMETIC SURGERY OF NEW YORK PC

Facility Address:
4616 NESCONSET HIGHWAY
PORT JEFFERSON STATION, NY
ZIP 11776
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Facility Phone Number: 631 473-7070

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1124229562

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	33D2225039
LAB Type	Physician Office
Facility Name	COSMETIC SURGERY OF NEW YORK PC
Street	4616 NESCONSET HIGHWAY
City	PORT JEFFERSON STATION
State	NY
ZIP	11776
Phone	631 473-7070
CertificateType	4
CertificateEffectiveDate	5/18/2021
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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