MEDICARE: PATRICK J MAHONEY DC, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	013735	NY

General Provider Information

NPI Number	:	1669257168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK J MAHONEY DC, MS

Provider Business Mailing Address
First Line	:	110 ZOTTI AVE
Second Line	:
City	:	OLD TAPPAN
State	:	NJ
Zip	:	07675-7457
Country	:	US
Telephone Number	:	845-570-1362
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 5TH AVE RM 1205
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-8016
Country	:	US
Telephone Number	:	212-924-2121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2023
Last Update Date	:	08/31/2023

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