Provider Demographics
NPI:1871980664
Name:GALICZYNSKI, DAN
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:GALICZYNSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:IVYLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18974-1710
Mailing Address - Country:US
Mailing Address - Phone:215-675-8506
Mailing Address - Fax:
Practice Address - Street 1:116 CHASE AVE
Practice Address - Street 2:
Practice Address - City:IVYLAND
Practice Address - State:PA
Practice Address - Zip Code:18974-1710
Practice Address - Country:US
Practice Address - Phone:215-675-8506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN603490163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse