Individual
MRS. REENA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
18 SQUADRON BLVD, NEW CITY, NY 10956-5210
(845) 634-9726
(845) 634-9018
Mailing address
18 SQUADRON BLVD, NEW CITY, NY 10956-5210
(845) 634-9729
(845) 634-9018
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MA64351
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0408529
GHI
NJ
05
—
7045107
—
NJ
01
—
P00619209
RAILROAD MCR
NJ
Enumeration date
09/26/2006
Last updated
12/06/2013
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