1003129826 NPI number — BIOSERENITY DT INC.

Table of content: (NPI 1003129826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003129826 NPI number — BIOSERENITY DT INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIOSERENITY DT 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:
6
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:
1003129826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CORPORATE PL
Provider Second Line Business Mailing Address:
SUITE 5B
Provider Business Mailing Address City Name:
PEABODY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01960-3840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-536-7400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13662 OFFICE PL
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22192-4217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-580-4679
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSELL
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
770-330-7836

Provider Taxonomy Codes

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

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

  • Identifier: FVS029 . This is a "MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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