31D2200591 CLIA NUMBER - FREEDOM SURGICAL CENTER LLC

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Laboratory Demographics

CLIA Number: 31D2200591

Facility Name: FREEDOM SURGICAL CENTER LLC

Facility Address:
1455 BROAD STREET SUITE 100
BLOOMFIELD, NJ
ZIP 07003
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Facility Phone Number: 201 478-9160

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1043811599

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	31D2200591
LAB Type	Ambulatory Surgery Center
Facility Name	FREEDOM SURGICAL CENTER LLC
Street	1455 BROAD STREET SUITE 100
City	BLOOMFIELD
State	NJ
ZIP	07003
Phone	201 478-9160
CertificateType	4
CertificateEffectiveDate	11/16/2022
CertificateExpirationDate	11/15/2024
FacilityType	Waiver

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