Healthcare Provider Details

I. General information

NPI: 1730802687
Provider Name (Legal Business Name): JAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CUMMINGS PARK STE 6250
WOBURN MA
01801-6372
US

IV. Provider business mailing address

800 W CUMMINGS PARK STE 6250
WOBURN MA
01801-6372
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-2112
  • Fax:
Mailing address:
  • Phone: 781-776-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH GREGORY KLINE BENEDICT
Title or Position: OWNER
Credential:
Phone: 425-737-0456