Provider Demographics
NPI:1336449347
Name:AMERICAN RADIOLOGY SERVICES BANYAN CENTER, LLC
Entity type:Organization
Organization Name:AMERICAN RADIOLOGY SERVICES BANYAN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-430-4674
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3027
Mailing Address - Country:US
Mailing Address - Phone:631-517-8006
Mailing Address - Fax:631-517-8007
Practice Address - Street 1:8903 GLADES RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4074
Practice Address - Country:US
Practice Address - Phone:561-218-9011
Practice Address - Fax:561-218-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC74912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty