07D1086403 CLIA NUMBER - BLACK ROCK DIALYSIS

Laboratory Demographics

  • CLIA Code: 07D1086403
  • Facility Name: BLACK ROCK DIALYSIS
  • Facility Address: 427 STILLSON ROAD
    FAIRFIELD, CT
    ZIP 06824
  • Facility Phone: 203 382-9566
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: ROBERT C. KIM
  • NPI Number: 1558524512
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 07D1086403
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name BLACK ROCK DIALYSIS
Street 427 STILLSON ROAD
City FAIRFIELD
State CT
ZIP 06824
Phone 203 382-9566
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2024
Certificate Expiration Date 7/10/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director ROBERT C. KIM

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