Provider Demographics
NPI:1508484635
Name:MAHONEY, JOAN CATHERINE (NP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:CATHERINE
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2094 WANTAGH AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3914
Mailing Address - Country:US
Mailing Address - Phone:516-528-2617
Mailing Address - Fax:516-781-2542
Practice Address - Street 1:732 SMITHTOWN BYP STE 206
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5020
Practice Address - Country:US
Practice Address - Phone:631-485-6074
Practice Address - Fax:631-532-4060
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY431760363LA2100X
NY405325363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care