Organization
COLLABORATIVE LABORATORY SERVICES LLC
Active
Organization
COLLABORATIVE LABORATORY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIO PERUGINO (VP OF FINANCE & CFO)
(860) 714-4714
Entity
Organization
Contact information
Practice address
114 WOODLAND ST FL 5, HARTFORD, CT 06105-1208
(860) 714-2802
Mailing address
114 WOODLAND ST, HARTFORD, CT 06105-1208
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CL-0623
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004225597
—
CT
01
—
070CL0623CT01
ANTHEM BLUE CROSS
CT
01
—
2V4067
HEALTHNET
CT
Enumeration date
07/29/2006
Last updated
07/16/2026
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