31D0938869 CLIA NUMBER - PARKSIDE DIALYSIS

Laboratory Demographics

CLIA Number: 31D0938869

Facility Name: PARKSIDE DIALYSIS

Facility Address:
580 FRELINGHUYSEN AVENUE
NEWARK, NJ
ZIP 07112
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Facility Phone Number: 973 624-2226

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1104806785

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	31D0938869
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	PARKSIDE DIALYSIS
Street	580 FRELINGHUYSEN AVENUE
City	NEWARK
State	NJ
ZIP	07112
Phone	973 624-2226
CertificateType	4
CertificateEffectiveDate	1/15/2024
CertificateExpirationDate	1/14/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024