33D2162376 CLIA NUMBER - STATEN ISLAND SOUTH DIALYSIS

Laboratory Demographics

CLIA Number: 33D2162376

Facility Name: STATEN ISLAND SOUTH DIALYSIS

Facility Address:
30 SNEDEN AVE
STATEN ISLAND, NY
ZIP 10312
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Facility Phone Number: 718 356-2678

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1245731876

Taxonomy: 261QE0700X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	2/21/2019
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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