33D2273761 CLIA NUMBER - ST JOSEPH'S DIALYSIS - NORTHEAST

Laboratory Demographics

CLIA Number: 33D2273761

Facility Name: ST JOSEPH'S DIALYSIS - NORTHEAST

Facility Address:
4105 MEDICAL CENTER DR - 1ST FL RM 105
FAYETTEVILLE, NY
ZIP 13066
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Facility Phone Number: 315 329-2580

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1174760573

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2273761
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ST JOSEPH'S DIALYSIS - NORTHEAST
Street	4105 MEDICAL CENTER DR - 1ST FL RM 105
City	FAYETTEVILLE
State	NY
ZIP	13066
Phone	315 329-2580
CertificateType	4
CertificateEffectiveDate	12/19/2022
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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