1437160710 NPI number — BIOSERENITY USA INC.

Table of content: (NPI 1437160710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437160710 NPI number — BIOSERENITY USA INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIOSERENITY USA INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437160710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 ROSEWOOD DR STE 245
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVERS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01923-4537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-536-7400
Provider Business Mailing Address Fax Number:
978-535-9778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 COLUMBIANA DR
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-749-3599
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHOCK
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP CLINICAL OPERATIONS
Authorized Official Telephone Number:
214-532-3757

Provider Taxonomy Codes

  • Taxonomy code: 207QS1201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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