Provider Demographics
NPI:1184089856
Name:JEN, BENJAMIN T
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:T
Last Name:JEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ARLINGTON ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3936
Mailing Address - Country:US
Mailing Address - Phone:361-236-5360
Mailing Address - Fax:
Practice Address - Street 1:133 CLARENDON ST
Practice Address - Street 2:UNIT 171471
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5132
Practice Address - Country:US
Practice Address - Phone:361-236-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic