Provider Demographics
NPI:1992715890
Name:BIOSERENITY DT INC.
Entity type:Organization
Organization Name:BIOSERENITY DT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-532-3757
Mailing Address - Street 1:99 ROSEWOOD DR STE 245
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-4537
Mailing Address - Country:US
Mailing Address - Phone:978-536-7400
Mailing Address - Fax:
Practice Address - Street 1:1060 KINGS HWY N STE 309
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034
Practice Address - Country:US
Practice Address - Phone:610-543-6800
Practice Address - Fax:610-543-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0453320000OtherAMERIHEALTH PERS CHOICE
NJ0658107000OtherAMERIHEALTH
NJ7618325OtherAETNA
NJ0658107000OtherKEYSTONE
NJ0658107000OtherKEYSTONE