Wagner, John Raymond

Wagner, John Raymond is an individual health care provider with primary practice located at 7 Pulaski Rd , East Northport NY 11731-2442. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Wagner, John Raymond can be contacted via phone (631) 261-3322.

Contact Information

Primary practice address
7 Pulaski Rd East Northport NY 11731-2442
Phone: (631) 261-3322
Fax: (631) 368-5440
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 181212 New York

Profile Details

NPI number 1538120704
LBN Legal business name Wagner, John Raymond
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 29th, 2006
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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Identifiers

StateTypeNumberIssuer
All States NPI 1538120704 NPPES
New York MEDICAID 01280253

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