MEDICARE: MAS IMAGING PORTABLE X-RAY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1881141364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAS IMAGING PORTABLE X-RAY INC

Provider Business Mailing Address
First Line	:	90 ARRIVAL AVE STE 105
Second Line	:
City	:	RONKONKOMA
State	:	NY
Zip	:	11779-7361
Country	:	US
Telephone Number	:	631-912-7476
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 ARRIVAL AVE STE 105
Second Line	:
City	:	RONKONKOMA
State	:	NY
Zip	:	11779
Country	:	US
Telephone Number	:	631-912-7476
Fax Number	:

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	MARLO SUAZO
Credential	:
Telephone Number	:	631-912-7476

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	02/10/2026

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