Provider Demographics
NPI:1003129826
Name:BIOSERENITY DT INC.
Entity Type:Organization
Organization Name:BIOSERENITY DT INC.
Other - Org Name:SLEEPMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-330-7836
Mailing Address - Street 1:200 CORPORATE PL
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3840
Mailing Address - Country:US
Mailing Address - Phone:978-536-7400
Mailing Address - Fax:
Practice Address - Street 1:13662 OFFICE PL
Practice Address - Street 2:SUITE 104
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4217
Practice Address - Country:US
Practice Address - Phone:703-580-4679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFVS029OtherMEDICARE
MD=========124OtherTRICARE