Provider Demographics
NPI:1033102801
Name:JOSEPH C GRETZULA DO FAAD PA
Entity Type:Organization
Organization Name:JOSEPH C GRETZULA DO FAAD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRETZULA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-736-8514
Mailing Address - Street 1:100 NE 6TH ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-4162
Mailing Address - Country:US
Mailing Address - Phone:561-736-8514
Mailing Address - Fax:561-736-8587
Practice Address - Street 1:555 N CONGRESS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3320
Practice Address - Country:US
Practice Address - Phone:561-736-8514
Practice Address - Fax:561-736-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5031207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty