Provider Demographics
NPI:1770860074
Name:BANZALI, MARCOS FERROL
Entity Type:Individual
Prefix:MR
First Name:MARCOS
Middle Name:FERROL
Last Name:BANZALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 SWARTHMORE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-1730
Mailing Address - Country:US
Mailing Address - Phone:717-489-1700
Mailing Address - Fax:717-479-4759
Practice Address - Street 1:1037 SWARTHMORE RD
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17070-1730
Practice Address - Country:US
Practice Address - Phone:717-489-1700
Practice Address - Fax:717-479-4759
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA21643601372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion