Provider Demographics
NPI:1871740365
Name:MAHON, CHARLES (RN)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MAHON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 BLUE POINT RD
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1812
Mailing Address - Country:US
Mailing Address - Phone:631-627-3735
Mailing Address - Fax:
Practice Address - Street 1:628 BLUE POINT RD
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1812
Practice Address - Country:US
Practice Address - Phone:631-627-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY593136163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse