33D2282718 CLIA NUMBER - MID NASSAU OB-GYN PLLC

Laboratory Demographics

CLIA Number: 33D2282718

Facility Name: MID NASSAU OB-GYN PLLC

Facility Address:
1130 NORTH BROADWAY, SUITE 120
MASSAPEQUA, NY
ZIP 11758
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Facility Phone Number: 516 566-0805

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1720707169

Taxonomy: 207V00000X - Obstetrics & Gynecology
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

CLIA Record

Field Name	Field Value
CLIA Number	33D2282718
LAB Type	Physician Office
Facility Name	MID NASSAU OB-GYN PLLC
Street	1130 NORTH BROADWAY, SUITE 120
City	MASSAPEQUA
State	NY
ZIP	11758
Phone	516 566-0805
CertificateType	4
CertificateEffectiveDate	5/25/2023
CertificateExpirationDate	5/24/2025
FacilityType	Waiver

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