31D2011571 CLIA NUMBER - COASTAL ENDO, LLC

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Laboratory Demographics

CLIA Number: 31D2011571

Facility Name: COASTAL ENDO, LLC

Facility Address:
175 GUNNING RIVER RD BLDG A, UNIT 4
BARNEGAT, NJ
ZIP 08005
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Facility Phone Number: 609 654-0230

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1982924080

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	31D2011571
LAB Type	Ambulatory Surgery Center
Facility Name	COASTAL ENDO, LLC
Street	175 GUNNING RIVER RD BLDG A, UNIT 4
City	BARNEGAT
State	NJ
ZIP	08005
Phone	609 654-0230
CertificateType	4
CertificateEffectiveDate	8/18/2022
CertificateExpirationDate	8/17/2024
FacilityType	Waiver

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