Healthcare Provider Details

I. General information

NPI: 1134189335
Provider Name (Legal Business Name): CLINIGEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150A NEW BOSTON STREET
WOBURN MA
01801-6204
US

IV. Provider business mailing address

150A NEW BOSTON STREET
WOBURN MA
01801-6204
US

V. Phone/Fax

Practice location:
  • Phone: 781-937-8888
  • Fax: 781-583-5000
Mailing address:
  • Phone: 844-267-9674
  • Fax: 781-583-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number0805475
License Number StateMA

VIII. Authorized Official

Name: MICHAEL J CASARICO
Title or Position: CEO
Credential:
Phone: 802-863-4105