Provider Demographics
NPI:1932628252
Name:BENSKO, JILLIAN CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:CHRISTINE
Last Name:BENSKO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 FENWOOD RD STE 5002K
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6128
Mailing Address - Country:US
Mailing Address - Phone:617-525-9243
Mailing Address - Fax:617-525-1310
Practice Address - Street 1:60 FENWOOD RD STE 5002K
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-525-9243
Practice Address - Fax:617-525-1310
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant