33D2279435 CLIA NUMBER - WELLNESS FAMILY HEALTH NP, PC

Laboratory Demographics

CLIA Number: 33D2279435

Facility Name: WELLNESS FAMILY HEALTH NP, PC

Facility Address:
1424 RICHMOND AVE, STE C
STATEN ISLAND, NY
ZIP 10314
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Facility Phone Number: 646 763-4574

Facility Type: Other - NURSE PRACTITIONER

Certificate Type: Waiver

NPI Number: 1841903192

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	33D2279435
LAB Type	Other - NURSE PRACTITIONER
Facility Name	WELLNESS FAMILY HEALTH NP, PC
Street	1424 RICHMOND AVE, STE C
City	STATEN ISLAND
State	NY
ZIP	10314
Phone	646 763-4574
CertificateType	4
CertificateEffectiveDate	4/3/2023
CertificateExpirationDate	4/2/2025
FacilityType	Waiver

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