Provider Demographics
NPI:1457763492
Name:MAHONEY, ANNA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-5109
Mailing Address - Country:US
Mailing Address - Phone:908-910-7945
Mailing Address - Fax:
Practice Address - Street 1:1622 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-5109
Practice Address - Country:US
Practice Address - Phone:732-977-0919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-26
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00107000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist