31D1087714 CLIA NUMBER - FAYROUZ PEDIATRIC LLC

Laboratory Demographics

  • CLIA Code: 31D1087714
  • Facility Name: FAYROUZ PEDIATRIC LLC
  • Facility Address: 1135 MAIN STREET, 2ND FL
    CLIFTON, NJ
    ZIP 07011
  • Facility Phone: 973 928-3388
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HISHAM GADALLA
  • NPI Number: 1154571222
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 31D1087714
LAB Type Physician Office
Facility Name FAYROUZ PEDIATRIC LLC
Street 1135 MAIN STREET, 2ND FL
City CLIFTON
State NJ
ZIP 07011
Phone 973 928-3388
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/20/2025
Certificate Expiration Date 5/19/2027
Facility Type Physician Office
Lab Director HISHAM GADALLA

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