33D2165433 CLIA NUMBER - LONGWOOD DIALYSIS

Laboratory Demographics

CLIA Number: 33D2165433

Facility Name: LONGWOOD DIALYSIS

Facility Address:
931 BRUCKNER BLVD
BRONX, NY
ZIP 10459
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Facility Phone Number: 718 378-0921

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1407415243

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2165433
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LONGWOOD DIALYSIS
Street	931 BRUCKNER BLVD
City	BRONX
State	NY
ZIP	10459
Phone	718 378-0921
CertificateType	4
CertificateEffectiveDate	4/26/2019
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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