Provider Demographics
NPI:1316935612
Name:COLLETTA, JOSEPH ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:COLLETTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 GLADES RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6461
Mailing Address - Country:US
Mailing Address - Phone:561-395-2626
Mailing Address - Fax:561-395-7026
Practice Address - Street 1:690 MEADOWS ROAD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-955-2131
Practice Address - Fax:561-955-3755
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33516174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066936900Medicaid
FL93772XMedicare PIN
FLD63002Medicare UPIN