Matthew Robert Wagner in Port Jefferson Stati - Pediatric Orthopaedic Surgery
Matthew Robert Wagner - NPI 1114198751
Matthew Robert Wagner is a Pediatric Orthopaedic Surgery in Port Jefferson Stati, New York. Matthew Robert Wagner practices all healthcare services and medical treatments related to Pediatric Orthopaedic Surgery. The NPI Number for Matthew Robert Wagner is 1114198751. The last update date is 2019-11-05.
Matthew Robert Wagner's current location address is 1500 Route 112 Bldg 2c, Port Jefferson Stati, New York. You can contact this provider via phone number 6313718034 and fax number 6318287899. The mailing address for Matthew Robert Wagner is 1500 Route 112 Bldg 2c, Port Jefferson Stati, New York. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Matthew Robert Wagner |
|---|---|
| Address | 1500 Route 112 Bldg 2c, Port Jefferson Stati, New York |
| Phone Number | 6313718034 |
| Fax Number | 6318287899 |
| Sole Proprietor | Y |
| Credentials | MD |
NPI Number Detail
| NPI Number | 1114198751 |
|---|---|
| Provider Enumeration Date | 2008-03-21 |
| Last Updated Date | 2019-11-05 |
Provider Mailing Address Detail
| Address | 1500 Route 112 Bldg 2c |
|---|---|
| City | Port Jefferson Stati |
| State | New York (NY) |
| Post Code | 117768055 |
| Phone Number | 6313718034 |
| Fax Number | 6318287899 |
Provider's Primary Taxonomy Detail
| Speciality | Pediatric Orthopaedic Surgery |
|---|---|
| Taxonomy | 207Xp3100X |
| Licence No | ME103612 |
|
Definition: An orthopedic surgeon who has additional training and experience in diagnosing, treating and managing musculoskeletal problems in infants, children and adolescents. These may include limb and spine deformities (such as club foot, scoliosis); gait abn |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 120130521000407 | NY | MEDICARE |
Post Comment/ Review Below
What is the unique 10-digit identification code assigned to Matthew Robert Wagner by the Centers for Medicare & Medicaid Services?
The Matthew Robert Wagner has been issued the NPI (National Provider Identifier) 1114198751, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete physical location address of Matthew Robert Wagner?
The Matthew Robert Wagner is physically situated at 1500 Route 112 Bldg 2C, in the city of Port Jefferson Stati, state of NY, with the postal code 117768055.
What is Matthew Robert Wagner's specialized field of practice, and what is the corresponding taxonomy code that categorizes this area of expertise?
The area of specialization for Matthew Robert Wagner is Pediatric Orthopaedic Surgery, and the taxonomy code that classifies this field of practice is 207Xp3100X.
On what date did Matthew Robert Wagner receive its 1114198751 assignment from the Centers for Medicare & Medicaid Services?
The Matthew Robert Wagner was assigned its 1114198751 on 2008-03-21, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
As of what date was the information pertaining to Matthew Robert Wagner, such as address, specialty, and other details, last reviewed and confirmed to be accurate?
The information related to Matthew Robert Wagner, including its address, specialty, and other relevant details, was last reviewed and confirmed to be accurate on 2019-11-05.
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