NPIMap

Organization Active NPI

Mas Imaging Portable X-Ray Inc

  • Physiological Laboratory
  • Ronkonkoma, NY
National Provider Identifier
1144876483
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
MAS IMAGING PORTABLE X-RAY INC
Practice address
90 Arrival Ave Ste 105
Ronkonkoma, NY 11779-7361
Phone
(631) 551-5101
NPI assigned
Aug 13, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marlo Suazo
Title
Owner
Phone
(631) 551-5101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X Primary

Addresses

Primary practice location

90 Arrival Ave Ste 105
Ronkonkoma, NY 11779-7361

Mailing address

90 Arrival Ave Ste 105
Ronkonkoma, NY 11779-7361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191211002055 NY Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 8426480765 Practice locations: Ronkonkoma, NY

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Mas Imaging Portable Xray Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

90 Arrival Ave
Ste 105
Ronkonkoma, NY 11779
Phone (631) 551-5101

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1144876483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 ARRIVAL AVE STE 105",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117797361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 ARRIVAL AVE STE 105",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117797361",
            "telephone_number": "631-551-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAS IMAGING PORTABLE X-RAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-13",
        "last_updated": "2019-10-10",
        "status": "A",
        "authorized_official_last_name": "SUAZO",
        "authorized_official_first_name": "MARLO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-551-5101"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ronkonkoma, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.