33D2296685 CLIA NUMBER - MIRIAM GORDON PEDIATRIC NP PC

Laboratory Demographics

  • CLIA Code: 33D2296685
  • Facility Name: MIRIAM GORDON PEDIATRIC NP PC
  • Facility Address: 7 ISMAY STREET
    STATEN ISLAND, NY
    ZIP 10314
  • Facility Phone: 917 744-1740
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MIRIAM BLAU
  • NPI Number: 1306233408
  • Taxonomy: 363LP0200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 33D2296685
LAB Type Physician Office
Facility Name MIRIAM GORDON PEDIATRIC NP PC
Street 7 ISMAY STREET
City STATEN ISLAND
State NY
ZIP 10314
Phone 917 744-1740
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2024
Certificate Expiration Date 1/3/2026
Facility Type Physician Office
Lab Director MIRIAM BLAU

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