Individual
MR. JOHN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
35 COLGATE ST, JERSEY CITY, NJ 07302-3307
(201) 547-2093
Mailing address
510 WASHINGTON ST, FLOOR 2, CARLSTADT, NJ 07072-1508
(201) 245-5417
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00083700
NJ
Other
Enumeration date
05/17/2006
Last updated
04/29/2008
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