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General NPI Number Information
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NPI Number | 1841208345
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE LABORATORY SERVICES-MOUNT SINAI CAMPUS
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 114 WOODLAND ST
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City | HARTFORD
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State | CT
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Zip | 06105-1208
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Country | US
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Telephone | 860-714-2802
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Fax |
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Provider Business Mailing Address
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Address Line | 500 BLUE HILLS AVE
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City | HARTFORD
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State | CT
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Zip | 06112-1500
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF FINANCIAL MANAGE
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Name | DONALD STRACESKI
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Credential |
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Telephone | 860-714-4609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CL-0625
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License Number State | CT
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