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

Laboratory Demographics

  • CLIA Code: 33D2273761
  • Facility Name: ST JOSEPH'S DIALYSIS - NORTHEAST
  • Facility Address: 4105 MEDICAL CENTER DR - 1ST FL RM 105
    FAYETTEVILLE, NY
    ZIP 13066
  • Facility Phone: 315 329-2580
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. PAWAN K. RAO
  • NPI Number: 1174760573
  • Taxonomy: 261QE0700X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2022
Certificate Expiration Date 3/26/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. PAWAN K. RAO

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