Before you sign a clinic lease in NYC or Long Island

Three questions about the space

Every pre-lease review we perform starts from three questions, and the answers determine which professionals the practice needs and which parts of the space will change.

• What will happen in the space. Routine exams, vaccines, blood draws, imaging, minor procedures, sedation and compounding each place different demands on fire separation, power, plumbing and ventilation.
• Who owns the practice and what it will be called. Ownership structure and the name on the door can affect state licensure.
• What the building allows. The certificate of occupancy, the landlord's base-building systems and the physical routes for pipes, ducts and conduit set the limits of any layout.

Occupancy and fire separation in New York City

The 2022 NYC Building Code (opens an external site), which governs applications filed on or after November 7, 2022, places outpatient clinics and ambulatory care facilities in the same occupancy, Business Group B (BC 304.1). The requirements still differ. An outpatient clinic provides care on a less than 24-hour basis to patients who are not rendered incapable of self-preservation by the treatment. An ambulatory care facility treats patients who are, for example under general anesthesia or deep sedation.

Under BC 422.2, where four or more care recipients could be incapable of self-preservation at any one time, the facility must be separated from adjacent spaces, corridors and tenants by a fire partition, and BC 422.3 adds smoke compartment rules above a set floor area. One sedation-capable procedure suite can change the partitions, the door hardware and the corridor plan, so the decision belongs before the architect draws the layout. The architect or engineer of record determines the classification, and we build to it.

Article 28 and office-based surgery

Private practices delivering routine outpatient care do not need a New York State Department of Health license under Public Health Law Article 28. A practice that operates through a not-for-profit or business corporation other than a professional service corporation, however, may be found to operate a diagnostic and treatment center under 10 NYCRR 600.8 (opens an external site), and a name such as center or clinic, rather than the practitioners' own names, is treated as prima facie evidence of one. Article 28 construction goes through Certificate of Need review, whose thresholds were raised by amendments to 10 NYCRR 710.1 effective August 6, 2025.

Practices performing office-based surgery, meaning procedures that require general anesthesia or moderate or deep sedation, and any liposuction, must hold full accreditation under Public Health Law 230-d (opens an external site). Accreditation is the practice's obligation, yet it shapes the build through recovery space, medical gas storage and emergency power. Structure and naming are questions for the practice's healthcare attorney, ideally settled before the lease and the sign order.

The certificate of occupancy and the building itself

In New York City, converting a retail store (Group M) to a clinic (Group B) usually requires an alteration filing with the Department of Buildings and may require an amended certificate of occupancy. Zoning is a separate question. The 2024 City of Yes for Economic Opportunity amendments restructured the city's use groups, and the architect should confirm how the zoning resolution now treats the intended medical use at that address.

A former dental suite may contain nitrous oxide piping that must be removed or certified, and the existing sprinkler layout and ventilation rarely suit a new floor plan. A former clinic's sealed rooms, door operators, heat-welded sheet flooring, HVAC and backed-up circuits can often be reused in the new build-out when they are identified before demolition.

Work letter terms and fire protection

A landlord's vanilla box often excludes HVAC distribution, sprinkler head relocation, fire alarm devices and accessible toilet room upgrades. The work letter should state who pays for them and for any path-of-travel upgrades the filing triggers.

Every layout change in a sprinklered building moves sprinkler heads and fire alarm devices. In New York City, anyone who stores or handles non-flammable gas cylinders such as oxygen, nitrous oxide or carbon dioxide needs an FDNY Certificate of Fitness G-46 (opens an external site), and supervision of piped non-flammable medical gas systems calls for a G-71.

Long Island differences

Nassau and Suffolk projects are filed with the town or incorporated village building department, each with its own forms and review sequence. The 2025 New York State Uniform Code, based on the 2024 International Codes with state amendments, took effect December 31, 2025, and permit applications from that date must comply with it.

Medical offices generally need more parking than retail under town zoning codes, and a shortfall usually means a variance application to the town or village zoning board, which can add months. Check the ratio in the local code before signing. In parts of Suffolk without public sewer, a change to medical use may bring review under Article 6 of the Suffolk County Sanitary Code, which limits sewage flow by lot size, and a medical office is assigned a higher design flow than retail. The design professional should confirm the review for the site.

Items new clinics commonly miss

• A planned location and receptacle for each vaccine refrigerator, away from sinks
• A hand sink in each exam room, placed near existing plumbing
• A lockable network closet with its own cooling and circuit
• Camera, access control and data rough-in before drywall
• An accessible exam room (opens an external site) with space for the accessible exam table and weight scale that the Section 504 rule has required since July 8, 2026 of practices that receive HHS federal financial assistance, which HHS reads to include Medicaid and Medicare Part B; the practice's counsel confirms whether it applies
• Signage in the languages patients speak
• Storage for sharps and regulated medical waste
• A staff break room separate from clean supply
• Solid-core doors and insulated walls between exam rooms
• After-hours building access for a vaccine storage emergency

We build out independent clinics of all specialties and independent pharmacies across New York City and Long Island, most often in Queens, Brooklyn, Manhattan, Nassau and Suffolk. Layouts are developed with our interior design partners, and the electrical, plumbing, HVAC and low-voltage work is performed with licensed partner contractors.