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General NPI Number Information
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NPI Number | 1033102801
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Entity Type | Organization
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Legal Business Name | JOSEPH C GRETZULA DO FAAD PA
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 555 N CONGRESS AVE SUITE 201
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-3320
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Country | US
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Telephone | 561-736-8514
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Fax | 561-736-8587
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Provider Business Mailing Address
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Address Line | 100 NE 6TH ST UNIT 201
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-4162
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Country | US
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Telephone | 561-736-8514
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Fax | 561-736-8587
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH C GRETZULA
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Credential | DO
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Telephone | 561-736-8514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | OS5031
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License Number State | FL
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