Provider Demographics
NPI:1518976554
Name:BIOSERENITY USA INC.
Entity type:Organization
Organization Name:BIOSERENITY USA INC.
Other - Org Name:<UNAVAIL>
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:978-536-6332
Practice Address - Street 1:770 HEMLOCK ST
Practice Address - Street 2:SUITE C
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-745-9050
Practice Address - Fax:478-745-5125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
905532OtherBLUE CROSS
2860022OtherAETNA HMO
7618325OtherAETNA PPO
905532OtherBLUE CROSS
GAGRP5148Medicare PIN