31D2058517 CLIA NUMBER - VANGUARD SURGICAL CENTER, LLC

Laboratory Demographics

  • CLIA Code: 31D2058517
  • Facility Name: VANGUARD SURGICAL CENTER, LLC
  • Facility Address: 113 ESSEX STREET, SUITE 100
    MAYWOOD, NJ
    ZIP 07607
  • Facility Phone: 201 851-0802
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DANTE IMPLICITO
  • NPI Number: 1568855948
  • Taxonomy: 261QP2000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 31D2058517
LAB Type Ambulatory Surgery Center
Facility Name VANGUARD SURGICAL CENTER, LLC
Street 113 ESSEX STREET, SUITE 100
City MAYWOOD
State NJ
ZIP 07607
Phone 201 851-0802
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/8/2025
Certificate Expiration Date 5/7/2027
Facility Type Ambulatory Surgery Center
Lab Director DANTE IMPLICITO

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