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General NPI Number Information
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NPI Number | 1457536997
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Entity Type | Organization
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Legal Business Name | BIOSERENITY DT, INC.
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 1003 EASTON RD SUITE 101
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City | WILLOW GROVE
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State | PA
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Zip | 19090
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Country | US
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Telephone | 610-543-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 99 ROSEWOOD DR STE 245
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City | DANVERS
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State | MA
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Zip | 01923-4537
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Country | US
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Telephone | 978-536-7400
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Fax |
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Authorized Official
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Title or Position | EVP CLINICAL OPERATIONS
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Name | JANICE SHOCK
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Credential |
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Telephone | 214-532-3757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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