33D2106883 CLIA NUMBER - BOROUGH PARK DIALYSIS

Laboratory Demographics

CLIA Number: 33D2106883

Facility Name: BOROUGH PARK DIALYSIS

Facility Address:
4102 13TH AVE
BROOKLYN, NY
ZIP 11219
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Facility Phone Number: 718 435-2112

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1699166926

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2106883
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BOROUGH PARK DIALYSIS
Street	4102 13TH AVE
City	BROOKLYN
State	NY
ZIP	11219
Phone	718 435-2112
CertificateType	4
CertificateEffectiveDate	12/30/2015
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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