Provider Demographics
NPI: | 1285893834 |
---|---|
Name: | GALKOWSKI, DARIUSZ (MD) |
Entity type: | Individual |
Prefix: | MR |
First Name: | DARIUSZ |
Middle Name: | |
Last Name: | GALKOWSKI |
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: | 153 W 11TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10011-8305 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 212-604-8393 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 153 W 11TH ST |
Practice Address - Street 2: | |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10011-8305 |
Practice Address - Country: | US |
Practice Address - Phone: | 212-604-8393 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-06-07 |
Last Update Date: | 2024-04-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | P63985 | 207ZP0102X, 207ZP0102X |
NJ | 25MA08613700 | 207ZC0006X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
Yes | 207ZC0006X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | P00917910 | Other | RR MCR |
NJ | 0206946 | Medicaid | |
NJ | 161580CTA | Medicare PIN |