Individual
BRIAN J WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1176 FIFITH AVENUE E LEVEL, NEW YORK, NY 10029-6501
(212) 659-8557
(212) 369-2385
Mailing address
5 EAST 98TH STREET BOX 1170, NEW YORK, NY 10029-6501
(212) 241-5681
(212) 348-7438
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
225630
NY
207VM0101X
Maternal & Fetal Medicine Physician
Primary
225630
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02532754
—
NY
Enumeration date
10/17/2006
Last updated
03/22/2012
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