Provider Demographics
NPI:1720768658
Name:COLAB, LLC
Entity type:Organization
Organization Name:COLAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:FREISINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-798-2532
Mailing Address - Street 1:2709 PAN AMERICAN FWY NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1650
Mailing Address - Country:US
Mailing Address - Phone:505-798-2532
Mailing Address - Fax:
Practice Address - Street 1:2709 PAN AMERICAN FWY NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1650
Practice Address - Country:US
Practice Address - Phone:505-798-2532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory