39D2165614 CLIA NUMBER - OLD FORGE DIALYSIS

Laboratory Demographics

  • CLIA Code: 39D2165614
  • Facility Name: OLD FORGE DIALYSIS
  • Facility Address: 325 S MAIN ST
    OLD FORGE, PA
    ZIP 18518
  • Facility Phone: (570) 457-3174
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. ASAD SHAFIQ
  • NPI Number: 1760444533
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D2165614
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name OLD FORGE DIALYSIS
Street 325 S MAIN ST
City OLD FORGE
State PA
ZIP 18518
Phone 5704573174
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/2/2025
Certificate Expiration Date 5/1/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. ASAD SHAFIQ

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This page was last updated on: 6/29/2026