Sovereign Medical Group LLC [1]
Facility ID:
W057
Site ID:
0000
CLIA Number:
33D2105318
Sovereign Medical Group LLC
1086 Forest Ave
Staten Island [2]
County:
Richmond [3]
NY [4]
10310 [5]
United States [6]
(347) 774-8386
Fax Number:
(718) 981-4261
11/25/2025
Director's Name:
Jay Boiser Basillote, M.D.
Primary Contact:
Arslan Shuaib
Contact Telephone Number:
(201) 855-8477
Certificate Type:
WAIVER [7]
Tests:
Urinalysis [8]