Sovereign Medical Group LLC
Name
Sovereign Medical Group LLC
Director
Jay Boiser Basillote, M.D.
Expiration Date
Phone Number
(347) 774-8386
UID (Facility ID - Site ID)
W057-0000
Site ID
0000
City
Staten Island
CLIA Number
33D2105318
Street Address
1086 Forest Ave
State
NY
Zip Code
10310
County
Richmond
Country
United States
Fax Number
(718) 981-4261
Primary Contact
Arslan Shuaib
Contact Phone Number
(201) 855-8477
Certificate Type
WAIVER
Tests
Urinalysis
Facility ID
W057