33D2278335 CLIA NUMBER - STATEN ISLAND GSC

Laboratory Demographics

CLIA Number: 33D2278335

Facility Name: STATEN ISLAND GSC

Facility Address:
2043 RICHMOND AVE - 1ST FL
STATEN ISLAND, NY
ZIP 10314
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Facility Phone Number: 718 975-7574

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1033815915

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2278335
LAB Type	Ambulatory Surgery Center
Facility Name	STATEN ISLAND GSC
Street	2043 RICHMOND AVE - 1ST FL
City	STATEN ISLAND
State	NY
ZIP	10314
Phone	718 975-7574
CertificateType	4
CertificateEffectiveDate	3/15/2023
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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