Wagner, Jack

Wagner, Jack is an sole proprietor health care provider with primary practice located at 37 Wilputte Pl , New Rochelle NY 10804-1426. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Wagner, Jack can be contacted via phone (914) 636-5678.

Contact Information

Primary practice address
37 Wilputte Pl New Rochelle NY 10804-1426
Fax: (914) 235-0153
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 90773 New York

Profile Details

NPI number 1578775326
LBN Legal business name Wagner, Jack
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 4th, 2007
Last updated Jul 8th, 2007 - about 19 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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