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CENTERS FOR MEDICARE & MEDICAID SERVICES CLINICAL LABORATORY IMPROVEMENT AMENDMENTS CERTIFICATE OF ACCREDITATION LABORATORY NAME AND ADDRESS AMERIPATH NEW YORK, LLC ONE MALCOLM AVENUE, SUITE A TETERBORO, NJ 07608 LABORATORY DIRECTOR LEZA N GALLO M.D. CLLV ID NUMBER 31D2100446 EFFECTIVE DATE 03/08/2019 EXPIRATION DATE 03/07/2021 Pursuant to Section 353 of the 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 of performing laboratory examinations or procedures. This certificate shall be valid untf the ^{ration date abov^ but is subject to revocation, suspension, limitation, or odier sanctions tor violation ortheAct or the r^ulations promulgated thereunder. CENTERS FORMEDICARE & MEDICAIDSERVICES certs2 021219 Kareti W. Dyer, Acting Director Division of Laboratory Services Survey and Certification Group Center for Clinical Standards and Quality If you currently hold aCertificate of Compliance or Certificate of Accreditation, below is alist of the laboratory specialties/subspecialties you are certified to perform and their effective date: LAB CERTIFICATION (CODF^ HISTOPATHOLOGY (610) ORAL PATHOLOGY (620) CYTOLOGY (630) EFFECTrVF. DATF 03/08/2017 03/08/2017 03/08/2017 LAB CERTIFICATION (CODF.^ EFFECTIVF, DATF ri. r „ -.s-.-riif fc- FORMORE INFORMATION ABOUT CLL\, VISIT OUR WEBSITE AT WWW.CMS.GOV/CLIA OR 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.
