Healthcare Provider Details

I. General information

NPI: 1104879030
Provider Name (Legal Business Name): HERBERT J DYRSZKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 GRAMERCY PARK N SUITE 1B
NEW YORK NY
10010-5423
US

IV. Provider business mailing address

60 GRAMERCY PARK N SUITE 1B
NEW YORK NY
10010-5423
US

V. Phone/Fax

Practice location:
  • Phone: 212-254-1220
  • Fax: 212-254-1387
Mailing address:
  • Phone: 212-254-1220
  • Fax: 212-254-1387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number138301
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: