Provider Demographics
NPI:1568497824
Name:GRELLA, WILLIAM F (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:GRELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:224 HAMBURG TPKE
Mailing Address - Street 2:RM. 4023
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2111
Mailing Address - Country:US
Mailing Address - Phone:973-956-3357
Mailing Address - Fax:973-389-4050
Practice Address - Street 1:224 HAMBURG TPKE
Practice Address - Street 2:RM. 4023
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2111
Practice Address - Country:US
Practice Address - Phone:973-956-3357
Practice Address - Fax:973-389-4050
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07304300207R00000X
NY221446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8898804Medicaid
059926Medicare ID - Type Unspecified
H68656Medicare UPIN