33D0984597 CLIA NUMBER - NONNA DATIASHVILI MD

Laboratory Demographics

  • CLIA Code: 33D0984597
  • Facility Name: NONNA DATIASHVILI MD
  • Facility Address: 227 KOCH BLVD
    STATEN ISLAND, NY
    ZIP 10312
  • Facility Phone: 718 605-7000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NONNA DATIASHVILI
  • NPI Number: 1326032673
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 33D0984597
LAB Type Physician Office
Facility Name NONNA DATIASHVILI MD
Street 227 KOCH BLVD
City STATEN ISLAND
State NY
ZIP 10312
Phone 718 605-7000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/26/2025
Certificate Expiration Date 3/25/2027
Facility Type Physician Office
Lab Director NONNA DATIASHVILI

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