41D2154673 CLIA NUMBER - PROVIDENCE INTERVENTIONAL ASSOCIATES II, LLC

Laboratory Demographics

  • CLIA Code: 41D2154673
  • Facility Name: PROVIDENCE INTERVENTIONAL ASSOCIATES II, LLC
  • Facility Address: 100 HIGHLAND AVE STE 100
    PROVIDENCE, RI
    ZIP 02906
  • Facility Phone: 401 277-9729
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONAH M. LICHT MD
  • NPI Number: 1588140818
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 41D2154673
LAB Type Physician Office
Facility Name PROVIDENCE INTERVENTIONAL ASSOCIATES II, LLC
Street 100 HIGHLAND AVE STE 100
City PROVIDENCE
State RI
ZIP 02906
Phone 401 277-9729
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/18/2024
Certificate Expiration Date 9/17/2026
Facility Type Physician Office
Lab Director JONAH M. LICHT MD

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