Provider Demographics
NPI:1003329988
Name:O'MAHONY, CORNELIA SABINE HEUCHERT (DIPLOM, LAC)
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:SABINE HEUCHERT
Last Name:O'MAHONY
Suffix:
Gender:F
Credentials:DIPLOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08825-0111
Mailing Address - Country:US
Mailing Address - Phone:908-797-2930
Mailing Address - Fax:
Practice Address - Street 1:17 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08530-1821
Practice Address - Country:US
Practice Address - Phone:908-528-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00071600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist