33D2061692 CLIA NUMBER - VITASTAT MEDICAL PLLC

Laboratory Demographics

  • CLIA Code: 33D2061692
  • Facility Name: VITASTAT MEDICAL PLLC
  • Facility Address: 2322 BROADWAY
    ASTORIA, NY
    ZIP 11106
  • Facility Phone: 347 829-6680
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. KEN TRUONG
  • NPI Number: 1811232770
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D2061692
LAB Type Physician Office
Facility Name VITASTAT MEDICAL PLLC
Street 2322 BROADWAY
City ASTORIA
State NY
ZIP 11106
Phone 347 829-6680
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2025
Certificate Expiration Date 7/8/2027
Facility Type Physician Office
Lab Director DR. KEN TRUONG

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