07D1089799 CLIA NUMBER - CONNECTICUT IMAGE GUIDED SURGERY

Laboratory Demographics

  • CLIA Code: 07D1089799
  • Facility Name: CONNECTICUT IMAGE GUIDED SURGERY
  • Facility Address: 501 KINGS HIGHWAY EAST, STE 109
    FAIRFIELD, CT
    ZIP 06825
  • Facility Phone: 203 330-0248
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DIETRICH W L SCHULTZE
  • NPI Number: 1730148784
  • Taxonomy: 2085R0204X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 07D1089799
LAB Type Physician Office
Facility Name CONNECTICUT IMAGE GUIDED SURGERY
Street 501 KINGS HIGHWAY EAST, STE 109
City FAIRFIELD
State CT
ZIP 06825
Phone 203 330-0248
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/26/2024
Certificate Expiration Date 9/25/2026
Facility Type Physician Office
Lab Director DIETRICH W L SCHULTZE

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