Healthcare Provider Details

I. General information

NPI: 1336449347
Provider Name (Legal Business Name): AMERICAN RADIOLOGY SERVICES BANYAN CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8903 GLADES RD SUITE B-1
BOCA RATON FL
33434-4074
US

IV. Provider business mailing address

500 W MAIN ST SUITE 108
BABYLON NY
11702-3027
US

V. Phone/Fax

Practice location:
  • Phone: 561-218-9011
  • Fax: 561-218-9012
Mailing address:
  • Phone: 631-517-8006
  • Fax: 631-517-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberHCC7491
License Number StateFL

VIII. Authorized Official

Name: DR. MARK J. MARZANO
Title or Position: OWNER
Credential: MD
Phone: 239-430-4674