Basic Information
| Provider Information | |||||||||
| NPI: | 1851333454 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIOSERENITY DT INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 ROSEWOOD DR STE 245 | ||||||||
| Address2: | |||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019234537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785367400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 99 ROSEWOOD DR STE 185 | ||||||||
| Address2: | |||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019231300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818489111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
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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: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | 409503 | 01 | MA | BLUE CHIP | OTHER | 2860005 | 01 | MA | AETNA HMO | OTHER | 6178 | 01 | MA | FALLON | OTHER | 7618325 | 01 | MA | AETNA PPO | OTHER | 9468 | 01 | MA | NEIGHBORHOOD HEALTH MA | OTHER | P00008307 | 01 | MA | RAILROAD MEDICARE | OTHER | M16564 | 01 | MA | BCBS OF MA-PROF AND ECG | OTHER | 0274 | 01 | MA | NEIGHBORHOOD HEALTH RI | OTHER | 626067 | 01 | MA | HARVARD PILGRIM | OTHER | 110087093A | 05 | MA | MEDICAID | 3400027 | 01 | MA | UNITED HEALTHCARE | OTHER | SF038169 | 01 | MA | BCBS OF MA | OTHER | 22164 | 01 | MA | BCBS OF RI | OTHER | 327004 | 01 | MA | BCBS MA TECHNICAL | OTHER | 607536 | 01 | MA | TUFTS | OTHER |