33D2162376 CLIA NUMBER - STATEN ISLAND SOUTH DIALYSIS

Laboratory Demographics

  • CLIA Code: 33D2162376
  • Facility Name: STATEN ISLAND SOUTH DIALYSIS
  • Facility Address: 30 SNEDEN AVE
    STATEN ISLAND, NY
    ZIP 10312
  • Facility Phone: 718 356-2678
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. JAUDAT H. KHAN
  • NPI Number: 1245731876
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D2162376
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name STATEN ISLAND SOUTH DIALYSIS
Street 30 SNEDEN AVE
City STATEN ISLAND
State NY
ZIP 10312
Phone 718 356-2678
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2019
Certificate Expiration Date 3/26/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. JAUDAT H. KHAN

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