Provider Demographics
NPI:1588865513
Name:JOSLIN DIABETES CLINIC, INC
Entity type:Organization
Organization Name:JOSLIN DIABETES CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENBOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-226-5745
Mailing Address - Street 1:1 JOSLIN PL
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5306
Mailing Address - Country:US
Mailing Address - Phone:617-732-2400
Mailing Address - Fax:
Practice Address - Street 1:1 JOSLIN PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5306
Practice Address - Country:US
Practice Address - Phone:617-732-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4S33332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACH7221OtherRR MEDICARE GROUP #
MA9784373Medicaid
MAM20594Medicare ID - Type UnspecifiedGROUP PROVIDER #
MACH7221OtherRR MEDICARE GROUP #
MAM21030Medicare ID - Type UnspecifiedGROUP PROVIDER #
MAM20590Medicare ID - Type UnspecifiedGROUP PROVIDER #
MAM20593Medicare ID - Type UnspecifiedGROUP PROVIDER #