Grand Boulevard Dialysis
Director
							Sushil Sagar, M.D.
			Expiration Date
							Phone Number
							(631) 243-7770
			UID (Facility ID - Site ID)
							Y474-0000
			Site ID
							0000
			City
							Deer Park
			CLIA Number
							33D2171632
			Street Address
							860 Grand Blvd
			State
							NY
			Zip Code
							11729
			County
							Suffolk
			Country
							United States
			Fax Number
							(631) 243-7775
			Primary Contact
							Carrie Pence
			Contact Phone Number
							(615) 341-6410
			Certificate Type
							WAIVER
			Tests
				Glucose
					Facility ID
							Y474
			