33D2259996 CLIA NUMBER - BLOOMING PEDIATRIC & FAMILY NURSE PRACTITIONERS PLLC

Laboratory Demographics

CLIA Number: 33D2259996

Facility Name: BLOOMING PEDIATRIC & FAMILY NURSE PRACTITIONERS PLLC

Facility Address:
1 OXFORD CROSSING SUITE 3
NEW HARTFORD, NY
ZIP 13413
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Facility Phone Number: 315 662-0162

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1801548177

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	33D2259996
LAB Type	Practitioner Other
Facility Name	BLOOMING PEDIATRIC & FAMILY NURSE PRACTITIONERS PLLC
Street	1 OXFORD CROSSING SUITE 3
City	NEW HARTFORD
State	NY
ZIP	13413
Phone	315 662-0162
CertificateType	4
CertificateEffectiveDate	5/13/2024
CertificateExpirationDate	5/12/2026
FacilityType	Waiver

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