33D2272639 CLIA NUMBER - COMPLEXION MEDICAL PLLC PARK AVENUE DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 33D2272639
  • Facility Name: COMPLEXION MEDICAL PLLC PARK AVENUE DERMATOLOGY
  • Facility Address: 580 PARK AVENUE
    NEW YORK, NY
    ZIP 10065
  • Facility Phone: 212 752-3692
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRADLEY GLODNY
  • NPI Number: 1497490429
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 33D2272639
LAB Type Physician Office
Facility Name COMPLEXION MEDICAL PLLC PARK AVENUE DERMATOLOGY
Street 580 PARK AVENUE
City NEW YORK
State NY
ZIP 10065
Phone 212 752-3692
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/28/2024
Certificate Expiration Date 11/27/2026
Facility Type Physician Office
Lab Director BRADLEY GLODNY

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This page was last updated on: 3/20/2025