Provider Demographics
NPI:1770020562
Name:MAHONEY, LAURA (OROFACIAL MYOLOGIST)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:OROFACIAL MYOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 COLUMBIA TPKE STE 101
Mailing Address - Street 2:
Mailing Address - City:CASTLETON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9584
Mailing Address - Country:US
Mailing Address - Phone:518-669-9824
Mailing Address - Fax:
Practice Address - Street 1:1528 COLUMBIA TURNPIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-1203
Practice Address - Country:US
Practice Address - Phone:518-669-9824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist