CLIA License | 22D0069726 |
CAP | 3733701 |
State of California | CDS-00800075 |
State of Maryland | 548 |
State of Massachusetts | 5879 |
State of New York Department of Health | 4118 |
State of Pennsylvania | 25752A |
State of Rhode Island | LCO00856 |
Federal Tax ID | 31-1805826 |
NPI Number | 1023063062 |
Medicare License | S300288100 |