33D2171632 CLIA NUMBER - GRAND BOULEVARD DIALYSIS

Laboratory Demographics

  • CLIA Code: 33D2171632
  • Facility Name: GRAND BOULEVARD DIALYSIS
  • Facility Address: 860 GRAND BLVD
    DEER PARK, NY
    ZIP 11729
  • Facility Phone: 631 243-7770
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. SUSHIL SAGAR
  • NPI Number: 1386205714
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D2171632
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GRAND BOULEVARD DIALYSIS
Street 860 GRAND BLVD
City DEER PARK
State NY
ZIP 11729
Phone 631 243-7770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2019
Certificate Expiration Date 3/26/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. SUSHIL SAGAR

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