Provider Demographics
NPI:1689348534
Name:COLLABORATION HEALTHCARE CORP
Entity Type:Organization
Organization Name:COLLABORATION HEALTHCARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIHL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:203-947-2147
Mailing Address - Street 1:807 SMITH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-3230
Mailing Address - Country:US
Mailing Address - Phone:203-947-2147
Mailing Address - Fax:
Practice Address - Street 1:725 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4619
Practice Address - Country:US
Practice Address - Phone:203-947-2147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1Medicaid