Bagner, Jerome Edward

Bagner, Jerome Edward is an individual health care provider with primary practice located at 30 Hempstead Ave Ste 158, Rockville Centre NY 11570-4033. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Bagner, Jerome Edward can be contacted via phone (516) 764-6800.

Contact Information

Primary practice address
30 Hempstead Ave Ste 158 Rockville Centre NY 11570-4033
Phone: (516) 764-6800
Fax: (516) 764-7047
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 0022331 New York

Profile Details

NPI number 1609854249
LBN Legal business name Bagner, Jerome Edward
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 4th, 2006
Last updated Oct 16th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609854249 NPPES
New York MEDICAID 00405023

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