52D0391181 CLIA NUMBER - NORTHEAST OB/GYN, SC

Laboratory Demographics

  • CLIA Code: 52D0391181
  • Facility Name: NORTHEAST OB/GYN, SC
  • Facility Address: 7040 N PORT WASHINGTON RD STE 400
    GLENDALE, WI
    ZIP 53217
  • Facility Phone: 414 228-8888
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. GARY P. FAIT
  • NPI Number: 1508936154
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 52D0391181
LAB Type Physician Office
Facility Name NORTHEAST OB/GYN, SC
Street 7040 N PORT WASHINGTON RD STE 400
City GLENDALE
State WI
ZIP 53217
Phone 414 228-8888
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/28/2023
Certificate Expiration Date 10/27/2025
Facility Type Physician Office
Lab Director DR. GARY P. FAIT

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This page was last updated on: 9/29/2025