Dr. Matthew Robert Wagner, MD
Orthopaedic Surgery, Pediatric Orthopaedic Surgery in Port Jefferson Station, NY. Individual provider (NPI-1).
NPI number1114198751
StatusActive
Last updated in NPPESNov 5, 2019
Details
- NPI
- 1114198751
- Entity type
- Individual (NPI-1)
- Name
- Dr. Matthew Robert Wagner
- Credential
- MD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 21, 2008
- Last updated
- Nov 5, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207XP3100X | Orthopaedic Surgery, Pediatric Orthopaedic Surgery | 251727 | NY | Yes |
| 207XP3100X | Orthopaedic Surgery, Pediatric Orthopaedic Surgery | ME103612 | FL |
Practice location
1500 Route 112 Bldg 2cPort Jefferson Station, NY 11776-8055
Phone 631-371-8034 · Fax 631-828-7899
Mailing address
1500 Route 112 Bldg 2cPort Jefferson Station, NY 11776-8055
Phone 631-371-8034 · Fax 631-828-7899
Other practice locations
500 Commack Rd Unit 150
Commack, NY 11725-5009
Commack, NY 11725-5009
Phone 631-371-8034 · Fax 631-828-7899
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