Provider Demographics
NPI:1467477745
Name:MAHONEY, SCOTT WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WILLIAM
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:DC
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 312
Mailing Address - Street 2:
Mailing Address - City:CEDAR BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08018-0312
Mailing Address - Country:US
Mailing Address - Phone:609-704-1857
Mailing Address - Fax:
Practice Address - Street 1:1852 BURLINGTON MOUNT HOLLY RD
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-1070
Practice Address - Country:US
Practice Address - Phone:609-265-8100
Practice Address - Fax:609-265-8369
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00391500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ806872OtherAETNA
NJU52938Medicare UPIN
NJMA483029Medicare ID - Type Unspecified