Provider Demographics
NPI:1508948274
Name:COLLABORATIVE LABORATORY SERVICES-BRISTOL
Entity Type:Organization
Organization Name:COLLABORATIVE LABORATORY SERVICES-BRISTOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FOR FINANCIAL MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:STRACESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-714-4609
Mailing Address - Street 1:BREWSTER ROAD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BREWSTER ROAD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06011
Practice Address - Country:US
Practice Address - Phone:860-585-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCL-0622291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00422559700OtherBLUE CROSS MANAGED MEDICA
CT2V4067OtherHEALTHNET
CTN211376OtherPREFERRED ONE/FIRST CHOIC
CT620109OtherCONNECTICARE
CT620109OtherCONNECTICARE