33D2091479 CLIA NUMBER - CORAM DIALYSIS CENTER

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Laboratory Demographics

CLIA Number: 33D2091479

Facility Name: CORAM DIALYSIS CENTER

Facility Address:
1500 MIDDLE COUNTRY RD
CENTEREACH, NY
ZIP 11720
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Facility Phone Number: 631 716-8758

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1043609415

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2091479
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	CORAM DIALYSIS CENTER
Street	1500 MIDDLE COUNTRY RD
City	CENTEREACH
State	NY
ZIP	11720
Phone	631 716-8758
CertificateType	4
CertificateEffectiveDate	2/13/2015
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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