Wagner, Jeffrey Todd

Wagner, Jeffrey Todd is an sole proprietor health care provider with primary practice located at 1 Gateway Drive , Wading River NY 11792. He recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist is his primary health care specialty. Wagner, Jeffrey Todd can be contacted via phone (631) 929-9200.

Contact Information

Primary practice address
1 Gateway Drive Wading River NY 11792
Phone: (631) 929-9200
Fax: (631) 929-9201
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 023281 New York
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic 2251X0800X 023281 New York

Profile Details

NPI number 1437244050
LBN Legal business name Wagner, Jeffrey Todd
Credentials PT, DPT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 3rd, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1437244050 NPPES
New York Other 828749 MANAGED PHYSICAL NETWORK
New York Other QN6131 MANAGED PHYSICAL NETWORK
New York Other 127516 MANAGED PHYSICAL NETWORK

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