Basic Information
| Provider Information | |||||||||
| NPI: | 1437160710 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIOSERENITY USA INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 ROSEWOOD DR STE 245 | ||||||||
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| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019234537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785367400 | ||||||||
| FaxNumber: | 9785359778 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 COLUMBIANA DR | ||||||||
| Address2: | 100 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037493599 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHOCK | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP CLINICAL OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2145323757 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS1201X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Sleep Medicine | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.