Individual
AIDEN VANWAGENEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
102 PARK STREET, CR WOOD CANCER CENTER, GLENS FALLS, NY 12801-4403
(518) 926-6620
(518) 926-6626
Mailing address
100 PARK STREET, GLENS FALLS HOSPITAL - CREDENTIALING, GLENS FALLS, NY 12801-4413
(518) 926-6992
(518) 926-6983
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
033944
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/16/2025
Last updated
08/06/2025
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