41D2045963 CLIA NUMBER - JEFFREY WISHIK MD, JD

Laboratory Demographics

  • CLIA Code: 41D2045963
  • Facility Name: JEFFREY WISHIK MD, JD
  • Facility Address: 1 RANDALL SQUARE SUITE 409
    PROVIDENCE, RI
    ZIP 02904
  • Facility Phone: (401) 274-5150
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEFFREY WISHIK MD JD
  • NPI Number: 1376718718
  • Taxonomy: 2084N0400X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 41D2045963
LAB Type Physician Office
Facility Name JEFFREY WISHIK MD, JD
Street 1 RANDALL SQUARE SUITE 409
City PROVIDENCE
State RI
ZIP 02904
Phone 4012745150
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2024
Certificate Expiration Date 8/22/2026
Facility Type Physician Office
Lab Director JEFFREY WISHIK MD JD

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This page was last updated on: 5/18/2026