33D1004178 CLIA NUMBER - I M PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 33D1004178
  • Facility Name: I M PEDIATRICS PC
  • Facility Address: 64-12 FRESH POND RD
    RIDGEWOOD, NY
    ZIP 11385
  • Facility Phone: 718 497-1565
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. IWONA K. MIENKO
  • NPI Number: 1669456984
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 33D1004178
LAB Type Physician Office
Facility Name I M PEDIATRICS PC
Street 64-12 FRESH POND RD
City RIDGEWOOD
State NY
ZIP 11385
Phone 718 497-1565
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/1/2024
Certificate Expiration Date 1/31/2026
Facility Type Physician Office
Lab Director DR. IWONA K. MIENKO

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This page was last updated on: 6/4/2025