Individual
DR. JEFFREY TODD WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
1 GATEWAY DRIVE, WADING RIVER, NY 11792
(631) 929-9200
(631) 929-9201
Mailing address
1 GATEWAY DRIVE, WADING RIVER, NY 11792
(631) 929-9200
(631) 929-9201
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
023281
NY
2251X0800X
Orthopedic Physical Therapist
Primary
023281
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127516
VYTRA
NY
01
—
828749
MANAGED PHYSICAL NETWORK
NY
01
—
QN6131
BC/BS
NY
Enumeration date
10/03/2006
Last updated
09/11/2025
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