41D1079940 CLIA NUMBER - EAST SIDE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 41D1079940
  • Facility Name: EAST SIDE PEDIATRICS
  • Facility Address: 285 GOVERNOR ST 3RD FL
    PROVIDENCE, RI
    ZIP 02906
  • Facility Phone: 401 383-4411
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WILLIAM J. MOROCCO MD
  • NPI Number: 1518906965
  • Taxonomy: 1223E0200X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 41D1079940
LAB Type Physician Office
Facility Name EAST SIDE PEDIATRICS
Street 285 GOVERNOR ST 3RD FL
City PROVIDENCE
State RI
ZIP 02906
Phone 401 383-4411
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/11/2024
Certificate Expiration Date 2/10/2026
Facility Type Physician Office
Lab Director WILLIAM J. MOROCCO MD

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