33D2256204 CLIA NUMBER - MAIN STREET RADIOLOGY

Laboratory Demographics

CLIA Number: 33D2256204

Facility Name: MAIN STREET RADIOLOGY

Facility Address:
83-14 COOPER AVE
GLENDALE, NY
ZIP 11385
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Facility Phone Number: 718 428-1500

Facility Type: Other - RADIOLOGY

Certificate Type: Waiver

NPI Number: 1598852469

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	33D2256204
LAB Type	Other - RADIOLOGY
Facility Name	MAIN STREET RADIOLOGY
Street	83-14 COOPER AVE
City	GLENDALE
State	NY
ZIP	11385
Phone	718 428-1500
CertificateType	4
CertificateEffectiveDate	3/22/2022
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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