Healthcare Provider Details

I. General information

NPI: 1861719585
Provider Name (Legal Business Name): MARC D. DYRSZKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PONDFIELD RD
BRONXVILLE NY
10708-3706
US

IV. Provider business mailing address

622 W 168TH ST., PH 11-1130
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5974
  • Fax: 212-305-6193
Mailing address:
  • Phone: 212-305-5974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA136413
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number289275-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number136413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: