31D0973598 CLIA NUMBER - GASTRO SURGI CENTER OF NEW JERSEY, THE

Laboratory Demographics

CLIA Number: 31D0973598

Facility Name: GASTRO SURGI CENTER OF NEW JERSEY, THE

Facility Address:
1132 SPRUCE DRIVE
MOUNTAINSIDE, NJ
ZIP 07092
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Facility Phone Number: 908 317-0071

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1891881926

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	31D0973598
LAB Type	Physician Office
Facility Name	GASTRO SURGI CENTER OF NEW JERSEY, THE
Street	1132 SPRUCE DRIVE
City	MOUNTAINSIDE
State	NJ
ZIP	07092
Phone	908 317-0071
CertificateType	4
CertificateEffectiveDate	7/3/2023
CertificateExpirationDate	7/2/2025
FacilityType	Waiver

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