Healthcare Provider Details

I. General information

NPI: 1508426073
Provider Name (Legal Business Name): ANDRII MARYNIAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E 8TH ST
SIOUX FALLS SD
57103-7070
US

IV. Provider business mailing address

5 MARLBOROUGH RD
BROOKLYN NY
11226-2605
US

V. Phone/Fax

Practice location:
  • Phone: 929-503-6869
  • Fax:
Mailing address:
  • Phone: 929-503-6869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: