Provider Demographics
NPI:1144293994
Name:PURZYCKI, EDWARD J (PHD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:PURZYCKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 HARRISBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-3172
Mailing Address - Fax:717-544-3229
Practice Address - Street 1:2100 HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3172
Practice Address - Fax:717-544-3229
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005182L103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3321660000OtherINDEPENDENCE BLUE CROSS
PA001965635Medicaid
PA50055771OtherCAPITAL BLUE CROSS
PAP00694083OtherRAILROAD MEDICARE
PA299786000OtherMAGELLAN
PA377782OtherHEALTH AMERICA
PA7689406 NON-HMOOtherAETNA
PA000660054OtherHIGHMARK BLUE SHIELD
PA142898LG9Medicare PIN