33D2255334 CLIA NUMBER - CITY MEDICAL OF UPPER EAST SIDE PLLC DBA SUMMIT HEALTH

Laboratory Demographics

CLIA Number: 33D2255334

Facility Name: CITY MEDICAL OF UPPER EAST SIDE PLLC DBA SUMMIT HEALTH

Facility Address:
1865 BROADWAY
NEW YORK, NY
ZIP 10023
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Facility Phone Number: 908 977-9458

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1033512611

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2255334
LAB Type	Physician Office
Facility Name	CITY MEDICAL OF UPPER EAST SIDE PLLC DBA SUMMIT HEALTH
Street	1865 BROADWAY
City	NEW YORK
State	NY
ZIP	10023
Phone	908 977-9458
CertificateType	4
CertificateEffectiveDate	3/14/2022
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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