33D2317365 CLIA NUMBER - INNOVATIVE CARE NP IN FAMILY HEALTH PLLC

Laboratory Demographics

  • CLIA Code: 33D2317365
  • Facility Name: INNOVATIVE CARE NP IN FAMILY HEALTH PLLC
  • Facility Address: 1712 NOSTRAND AVE
    BROOKLYN, NY
    ZIP 11226
  • Facility Phone: 917 239-3094
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JEANNE E. VILSAINT
  • NPI Number: 1982468401
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 33D2317365
LAB Type Practitioner Other
Facility Name INNOVATIVE CARE NP IN FAMILY HEALTH PLLC
Street 1712 NOSTRAND AVE
City BROOKLYN
State NY
ZIP 11226
Phone 917 239-3094
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2025
Certificate Expiration Date 1/22/2027
Facility Type Practitioner Other
Lab Director JEANNE E. VILSAINT

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