Individual
ELLIOTT JAY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8750 WILSHIRE BLVD STE 100, BEVERLY HILLS, CA 90211-2708
(310) 689-3100
Mailing address
200 EAST 66TH ST, C904, NEW YORK, NY 10065-9175
(888) 886-5238
(888) 886-9330
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036120986
IL
2085R0202X
Diagnostic Radiology Physician
238657-1
NY
2085R0202X
Diagnostic Radiology Physician
25MA08122100
NJ
2085R0202X
Diagnostic Radiology Physician
Primary
G49698
CA
2085R0202X
Diagnostic Radiology Physician
MD2008-0777
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G496980
BLUE SHIELD
CA
05
—
00G496980
—
CA
05
—
02917751
—
NY
Enumeration date
05/15/2006
Last updated
07/29/2025
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