Individual
DIANE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
43 SHEBAR DR, ISLIP, NY 11751-4409
(631) 581-1119
Mailing address
43 SHEBAR DR, ISLIP, NY 11751-4409
(631) 581-1119
Taxonomy
Speciality
Code
Description
License number
State
207ZB0001X
Blood Banking & Transfusion Medicine Physician
182713
NY
207ZM0300X
Medical Microbiology Physician
Primary
182713
NY
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
182713
NY
2084P0800X
Psychiatry Physician
182713
NY
Other
Enumeration date
10/09/2006
Last updated
09/11/2025
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