Provider Demographics
NPI:1467481176
Name:DYNSKI, MARGUERITE (MD)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:
Last Name:DYNSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-0553
Mailing Address - Fax:585-922-3950
Practice Address - Street 1:1415 PORTLAND AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3038
Practice Address - Country:US
Practice Address - Phone:585-922-4715
Practice Address - Fax:585-922-3950
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131974208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010131974OtherBLUE CHOICE
NY0763OtherBLUE CROSS BLUE SHIELD
NY00694197Medicaid
NY100796FLOtherPREFERRED CARE
NY5400339OtherAETNA
NY00694197Medicaid
NY100796FLOtherPREFERRED CARE