Healthcare Provider Details

I. General information

NPI: 1598861114
Provider Name (Legal Business Name): JOY BRETTLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST ASB 2 LEVEL 3
BOSTON MA
02115-6110
US

IV. Provider business mailing address

101 WALK HILL ST
JAMAICA PLAIN MA
02130-4147
US

V. Phone/Fax

Practice location:
  • Phone: 617-459-2389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1179
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: