41D2294419 CLIA NUMBER - NORTHEAST INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 41D2294419
  • Facility Name: NORTHEAST INTERNAL MEDICINE
  • Facility Address: 126 PROSPECT STREET SUITE 205
    PAWTUCKET, RI
    ZIP 02860
  • Facility Phone: 401 725-8866
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SADIA IFTIKHAR
  • NPI Number: 1376746156
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 41D2294419
LAB Type Physician Office
Facility Name NORTHEAST INTERNAL MEDICINE
Street 126 PROSPECT STREET SUITE 205
City PAWTUCKET
State RI
ZIP 02860
Phone 401 725-8866
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/27/2023
Certificate Expiration Date 11/26/2025
Facility Type Physician Office
Lab Director SADIA IFTIKHAR

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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