Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. MATTHEW ROBERT WAGNER, MD
Active Sole ProprietorDR. MATTHEW ROBERT WAGNER, MD is a Pediatric Orthopaedic Surgery healthcare provider located in PORT JEFFERSON STATION, New York. NPI 1114198751 is currently active in the NPPES registry. Verify at CMS.
Pediatric Orthopaedic Surgery · PORT JEFFERSON STATION, NY
Registration Details
- NPI Number
- 1114198751
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Mar 21, 2008 (18.432724530392 yrs)
- Last Updated
- Nov 5, 2019
- Licenses
-
ME103612 (FL)251727 (NY)
- Sole Proprietor
- Yes
Practice Information
- Address
-
1500 ROUTE 112 BLDG 2CPORT JEFFERSON STATION, NY, 117768055Browse NY providers · Browse ZIP 11776
- Phone
- 6313718034
- Fax
- 6318287899
- Primary Specialty
-
Pediatric Orthopaedic Surgery
207XP3100X
- Additional Specialty
- Pediatric Orthopaedic Surgery
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.