Individual
MARLO SUAZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11 BAYARD ST, LAKE GROVE, NY 11755-3147
(631) 912-7476
Mailing address
11 BAYARD ST, LAKE GROVE, NY 11755-3147
(631) 912-7476
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
02/07/2014
Last updated
02/07/2014
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