CENTERS FOR MEDICARE & MEDICAID SERVICESCLINICAL LABORATORY IMPROVEMENT AMENDMENTS

CERTIFICATE OFACCREDITATION

LABORATORY NAME AND ADDRESSAMERIPATH NEW YORK, LLCONE MALCOLM AVENUE, SUITE ATETERBORO, NJ 07608

LABORATORY DIRECTOR

LEZA N GALLO M.D.

CLLV ID NUMBER31D2100446

EFFECTIVE DATE

03/08/2019

EXPIRATION DATE

03/07/2021

Pursuant to Section 353 ofthe Public Health ^rvi^ Act (42 U.S.C. 263a) as «™ed by the Clinical Laboratory Impro^ment Amendments (CLIA),the aboTC named laboratory located at the ad<tos shown hereon (and other approved locations) may accept human specimens

torthepurposes ofperforming laboratory examinations orprocedures.This certificate shall be valid untf the ^{ration date abov^ but is subject to revocation, suspension, limitation, or odier sanctions

torviolation ortheAct or ther^ulationspromulgated thereunder.

CENTERS FORMEDICARE & MEDICAIDSERVICES

certs2 021219

Kareti W. Dyer, Acting DirectorDivision of Laboratory ServicesSurvey and Certification GroupCenter forClinical Standards andQuality

Ifyou currently hold aCertificate of Compliance or Certificate ofAccreditation, below is alist of the laboratoryspecialties/subspecialties you are certified toperform andtheir effective date:

LAB CERTIFICATION (CODF^HISTOPATHOLOGY (610)

ORAL PATHOLOGY (620)

CYTOLOGY (630)

EFFECTrVF. DATF03/08/2017

03/08/2017

03/08/2017

LAB CERTIFICATION (CODF.^ EFFECTIVF, DATF

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FORMORE INFORMATION ABOUT CLL\, VISIT OUR WEBSITE AT WWW.CMS.GOV/CLIAOR CONTACT YOUR LOCAL STATE AGENCY PLEASE SEE THE REVERSE FOR

YOUR STATEAGENCY'S ADDRESS AND PHONE NUMBER.PLEASE CONTACT YOUR STATE AGENCY FOR ANY CHANGES TOYOUR CURRENT CERTIFICATE.