Individual provider Active NPI

Timothy Peter Mahoney, D.D.S.

  • Dentist
  • Buffalo, NY
National Provider Identifier
1659536837
Registry record updated Jul 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
042726 Issued in NY
Practice address
936 Delaware Ave
Suite 405
Buffalo, NY 14209-1880
Phone
(716) 884-7551
NPI assigned
Jul 27, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 042726 NY Primary

Addresses

Primary practice location

936 Delaware Ave
Suite 405
Buffalo, NY 14209-1880

Mailing address

936 Delaware Ave
Suite 405
Buffalo, NY 14209-1880
Phone (716) 884-7551

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160108000813 NY Order and Referring Only - DentistPractitioner - Dentist 4880996727

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
042726NYMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217116800000",
    "number": "1659536837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "936 DELAWARE AVE",
            "address_2": "SUITE 405",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142091880",
            "telephone_number": "716-884-7551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "936 DELAWARE AVE",
            "address_2": "SUITE 405",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142091880",
            "telephone_number": "716-884-7551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHONEY",
        "first_name": "TIMOTHY",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-27",
        "last_updated": "2008-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "042726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.