# JENIA WAGNER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1518939750
- **Gender:** F
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 172214 | NY | Yes |

## Other

- **Enumeration date:** 02/02/2006
- **Last updated:** 03/06/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00010164304 | UNIVERA | NY |
| 01 | — | 000524001006 | BC/BS | NY |
| 05 | — | 01608680 | — | NY |
| 01 | — | 0408107 | IHA | NY |
| 01 | — | 10166190 | FIDELIS | NY |
| 01 | — | 151114BJ | PREFERRED CARE | NY |