Provider Demographics
NPI:1134189335
Name:CLINIGEN, INC.
Entity type:Organization
Organization Name:CLINIGEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASARICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-863-4105
Mailing Address - Street 1:150A NEW BOSTON STREET
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6204
Mailing Address - Country:US
Mailing Address - Phone:844-267-9674
Mailing Address - Fax:781-583-5000
Practice Address - Street 1:150A NEW BOSTON STREET
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6204
Practice Address - Country:US
Practice Address - Phone:781-937-8888
Practice Address - Fax:781-583-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0805475291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0805475Medicaid
MA624374OtherHPHC
MA803635OtherTUFTS HEALTH PLAN
MANP0011570OtherBOSTON MEDICAL CENTER
MA0009335OtherNEIGHBORHOOD HEALTH PLAN
MA228422OtherBC/BS
MANP0011570OtherBOSTON MEDICAL CENTER