33D2040899 CLIA NUMBER - REVIVED SOUL MEDICAL PC

Laboratory Demographics

  • CLIA Code: 33D2040899
  • Facility Name: REVIVED SOUL MEDICAL PC
  • Facility Address: 1329 EAST 17TH STREET
    BROOKLYN, NY
    ZIP 11230
  • Facility Phone: (718) 382-5060
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. IRINA KIBLITSKY
  • NPI Number: 1821389941
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 33D2040899
LAB Type Physician Office
Facility Name REVIVED SOUL MEDICAL PC
Street 1329 EAST 17TH STREET
City BROOKLYN
State NY
ZIP 11230
Phone 7183825060
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/1/2024
Certificate Expiration Date 5/31/2026
Facility Type Physician Office
Lab Director DR. IRINA KIBLITSKY

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This page was last updated on: 5/18/2026