33D2322843 CLIA NUMBER - MEDIDENTAL

Laboratory Demographics

  • CLIA Code: 33D2322843
  • Facility Name: MEDIDENTAL
  • Facility Address: 2246 31ST ST
    ASTORIA, NY
    ZIP 11105
  • Facility Phone: 718 728-8800
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: DR. WALID MICHELEN
  • NPI Number: 1518439967
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D2322843
LAB Type Community Clinic
Facility Name MEDIDENTAL
Street 2246 31ST ST
City ASTORIA
State NY
ZIP 11105
Phone 718 728-8800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2025
Certificate Expiration Date 3/26/2027
Facility Type Community Clinic
Lab Director DR. WALID MICHELEN

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