Active NPI
Kevin Mahoney, PA
- Physician Assistant
- New Hartford, NY
National Provider Identifier
1013154566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 013093-1
- Practice address
- 8411 Seneca Turnpike
New Hartford, NY 13413-4308 - Phone
- (315) 624-8500
- Fax
- (315) 624-8515
- NPI assigned
- Jan 20, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 013093-1 | NY | Primary |
Addresses
Primary practice location
8411 Seneca Turnpike
New Hartford, NY 13413-4308
Mailing address
2209 Genesee Street
Business Office
Utica, NY 13501-5930
Phone (315) 801-3282
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03434035 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013093-1 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543276800000",
"number": "1013154566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2209 GENESEE STREET",
"address_2": "BUSINESS OFFICE",
"city": "UTICA",
"state": "NY",
"postal_code": "135015930",
"telephone_number": "315-801-3282",
"fax_number": "315-801-8391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8411 SENECA TURNPIKE",
"city": "NEW HARTFORD",
"state": "NY",
"postal_code": "134134308",
"telephone_number": "315-624-8500",
"fax_number": "315-624-8515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHONEY",
"first_name": "KEVIN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-01-20",
"last_updated": "2018-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "013093-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03434035",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Hartford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.