33D2270590 CLIA NUMBER - MONTGOMERY COUNTY CORRECTIONAL FACILITY

Laboratory Demographics

  • CLIA Code: 33D2270590
  • Facility Name: MONTGOMERY COUNTY CORRECTIONAL FACILITY
  • Facility Address: 200 CLARK DR
    FULTONVILLE, NY
    ZIP 12072
  • Facility Phone: 518 853-5528
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: MICHAEL GANDT
  • NPI Number: 1366122616
  • Taxonomy: 341600000X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 33D2270590
LAB Type Prison
Facility Name MONTGOMERY COUNTY CORRECTIONAL FACILITY
Street 200 CLARK DR
City FULTONVILLE
State NY
ZIP 12072
Phone 518 853-5528
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/18/2022
Certificate Expiration Date 3/26/2027
Facility Type Prison
Lab Director MICHAEL GANDT

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This page was last updated on: 9/29/2025