Healthcare Provider Details

I. General information

NPI: 1215936604
Provider Name (Legal Business Name): GEDDY JAY KRUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 HAGEN RANCH RD STE 760
BOYNTON BEACH FL
33437-3777
US

IV. Provider business mailing address

381 CHESTNUT ST
UNION NJ
07083-9430
US

V. Phone/Fax

Practice location:
  • Phone: 561-733-4400
  • Fax: 561-733-5004
Mailing address:
  • Phone: 908-688-8007
  • Fax: 908-688-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME174747
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA05108200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: