Individual
IRA J WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
ST VINCENTS HOSPITAL 153 WEST 11TH STREET, NEW YORK, NY 10011
(212) 604-8336
(212) 604-8061
Mailing address
222 W 14TH ST, NEW YORK, NY 10011-7200
(212) 604-1824
(212) 604-1892
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
131401
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00599500
—
NY
01
—
CF6456
RAILROAD MEDICARE
NY
Enumeration date
07/07/2006
Last updated
01/31/2008
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