Individual
DR. JACK WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
37 WILPUTTE PL, NEW ROCHELLE, NY 10804-1426
(914) 636-5678
(914) 235-0153
Mailing address
37 WILPUTTE PL, NEW ROCHELLE, NY 10804-1426
(914) 636-5678
(914) 235-0153
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
90773
NY
Other
Enumeration date
05/04/2007
Last updated
07/08/2007
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