Active NPI
Marlo Suazo
- Mobile Radiology Clinic/Center
- Lake Grove, NY
National Provider Identifier
1821412065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mobile Radiology Clinic/Center
- Practice address
- 11 Bayard St
Lake Grove, NY 11755-3147 - Phone
- (631) 912-7476
- NPI assigned
- Feb 7, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mobile Radiology Clinic/Center | 261QR0208X | Primary |
Addresses
Primary practice location
11 Bayard St
Lake Grove, NY 11755-3147
Mailing address
11 Bayard St
Lake Grove, NY 11755-3147
Phone (631) 912-7476
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391731200000",
"number": "1821412065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 BAYARD ST",
"city": "LAKE GROVE",
"state": "NY",
"postal_code": "117553147",
"telephone_number": "631-912-7476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 BAYARD ST",
"city": "LAKE GROVE",
"state": "NY",
"postal_code": "117553147",
"telephone_number": "631-912-7476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUAZO",
"first_name": "MARLO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-02-07",
"last_updated": "2014-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "261QR0208X",
"taxonomy_group": "",
"desc": "Clinic/Center, Radiology, Mobile",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Grove, NY
- Dawn Lynn Spring
- Scott A Stein, D.O.
- Stephanie Renee Grindell Mental Health Counselor, P.C. (The Grove Mental Health Counseling Services)
- Emily Harlan Stetler, MD
- Laura Marie Stonborg
- Sathish Jay Subbaiah, M.D.
- Suffolk Breast Imaging PC
- Suffolk Medical Imaging, PC
- Michelle Nicole Tallini, CF-SLP
- Kari Ann Tanury, LPN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.