Dr. Matthew Robert Wagner
Pediatric Orthopaedic Surgeon
1500 Route 112 Bldg 2c
Port Jefferson Station
, New York 11776-8055
Dr. Matthew Robert Wagner
Pediatric Orthopaedic Surgeon
1500 Route 112 Bldg 2c
Port Jefferson Station
, New York 11776-8055
(631) 828-7899
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About
Features
Specialties
- Pediatric Orthopaedic Surgeon
Languages spoken
- English
Location
First Address
- Dr. Matthew Robert Wagner
- 1500 Route 112 Bldg 2c
- Port Jefferson Station, NY
- Zip : 11776-8055
- Fax : (631) 828-7899
- Phone : (631) 371-8034
Second Address
- Dr. Matthew Robert Wagner
- 1500 Route 112 Bldg 2c
- Port Jefferson Station, NY
- Zip : 11776-8055
- Fax : (631) 828-7899
- Phone : (631) 371-8034
Reviews
FAQs
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Is Dr. Matthew Robert Wagner a sole practitioner?
Is Dr. Matthew Robert Wagner accepting new patients?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 251727 | NY |
| N | 207XP3100X | Pediatric Orthopaedic Surgeon | ME103612 | FL |
National Provider Identifier
| NPI | 1114198751 |
|---|---|
| Provider Name | Dr. Matthew Robert Wagner |
| First Address | Port Jefferson Station, NY 11776-8055 |
| Second Address | Port Jefferson Station, NY 11776-8055 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/03/2008 |
| Last Update Date | 05/11/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 120130521000407 | MEDICARE (01) | NY |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.