31D1093533 CLIA NUMBER - HACKENSACK SURGERY CENTER, LLC

Laboratory Demographics

CLIA Number: 31D1093533

Facility Name: HACKENSACK SURGERY CENTER, LLC

Facility Address:
19 KOTTE PLACE
HACKENSACK, NJ
ZIP 07601
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Facility Phone Number: 201 996-1921

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1356510408

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	31D1093533
LAB Type	Ambulatory Surgery Center
Facility Name	HACKENSACK SURGERY CENTER, LLC
Street	19 KOTTE PLACE
City	HACKENSACK
State	NJ
ZIP	07601
Phone	201 996-1921
CertificateType	4
CertificateEffectiveDate	12/22/2022
CertificateExpirationDate	12/21/2024
FacilityType	Waiver

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