Individual
UTE WAGNER ROSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20 PIERREPONT ST APT 3C, BROOKLYN, NY 11201-7204
(718) 643-7179
Mailing address
20 PIERREPONT ST APT 3C, BROOKLYN, NY 11201-7204
(718) 643-7179
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
129335
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01170323
—
NY
Enumeration date
03/31/2006
Last updated
12/15/2011
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