07D1085306 CLIA NUMBER - EVERGREEN ENDOSCOPY CENTER LLC

Laboratory Demographics

  • CLIA Code: 07D1085306
  • Facility Name: EVERGREEN ENDOSCOPY CENTER LLC
  • Facility Address: 2400 TAMARACK AVE STE 100
    SOUTH WINDSOR, CT
    ZIP 06074
  • Facility Phone: 860 646-6383
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: JOSEPH H. IANELLO
  • NPI Number: 1093974602
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 07D1085306
LAB Type Other
Facility Name EVERGREEN ENDOSCOPY CENTER LLC
Street 2400 TAMARACK AVE STE 100
City SOUTH WINDSOR
State CT
ZIP 06074
Phone 860 646-6383
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/13/2024
Certificate Expiration Date 6/12/2026
Facility Type Other
Lab Director JOSEPH H. IANELLO

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