33D2271116 CLIA NUMBER - PENINSULA PEDIATRICS

Laboratory Demographics

CLIA Number: 33D2271116

Facility Name: PENINSULA PEDIATRICS

Facility Address:
12105 ROCKAWAY BEACH BOULEVARD
ROCKAWAY PARK, NY
ZIP 11694
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Facility Phone Number: 718 412-9980

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1134843600

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2271116
LAB Type	Physician Office
Facility Name	PENINSULA PEDIATRICS
Street	12105 ROCKAWAY BEACH BOULEVARD
City	ROCKAWAY PARK
State	NY
ZIP	11694
Phone	718 412-9980
CertificateType	4
CertificateEffectiveDate	10/27/2022
CertificateExpirationDate	10/26/2024
FacilityType	Waiver

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