Provider Demographics
NPI:1669257168
Name:MAHONEY, PATRICK J (DC, MS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ZOTTI AVE
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7457
Mailing Address - Country:US
Mailing Address - Phone:845-570-1362
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE RM 1205
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8016
Practice Address - Country:US
Practice Address - Phone:212-924-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor