07D1010000 CLIA NUMBER - COASTAL DIGESTIVE CARE CENTER LLC

Laboratory Demographics

  • CLIA Code: 07D1010000
  • Facility Name: COASTAL DIGESTIVE CARE CENTER LLC
  • Facility Address: 5 DAYTON RD, STE 104
    WATERFORD, CT
    ZIP 06385
  • Facility Phone: 860 442-0290
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JOHN FRESE JR MD
  • NPI Number: 1447459839
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 07D1010000
LAB Type Ambulatory Surgery Center
Facility Name COASTAL DIGESTIVE CARE CENTER LLC
Street 5 DAYTON RD, STE 104
City WATERFORD
State CT
ZIP 06385
Phone 860 442-0290
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2025
Certificate Expiration Date 3/3/2027
Facility Type Ambulatory Surgery Center
Lab Director JOHN FRESE JR MD

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