Healthcare Provider Details

I. General information

NPI: 1720924996
Provider Name (Legal Business Name): DYANNA MARX-DUROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FRANKLIN ST
SCHENECTADY NY
12305-2101
US

IV. Provider business mailing address

79 GLENRIDGE RD
GLENVILLE NY
12302-4528
US

V. Phone/Fax

Practice location:
  • Phone: 518-372-7031
  • Fax: 518-372-7064
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number9837-P
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: