DR. MATTHEW ROBERT WAGNER (NPI# 1114198751) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114198751 |
| Entity Type | Individual |
| Full Name | DR. MATTHEW ROBERT WAGNER |
| Credential | MD |
| Practice Address |
1500 Route 112 Bldg 2c Port Jefferson Station NY 11776-8055 |
| Practice Telephone | 6313718034 |
| Practice Fax Number | 6318287899 |
| Mailing Telephone | 6313718034 |
| Mailing Fax Number | 6318287899 |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2019-11-05 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XP3100X |
Orthopaedic Surgery Specialization: Pediatric Orthopaedic Surgery |
251727 | NY | Allopathic & Osteopathic Physicians |
| N | 207XP3100X |
Orthopaedic Surgery Specialization: Pediatric Orthopaedic Surgery |
ME103612 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | MEDICARE | 120130521000407 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 500 Commack Rd Unit 150, Commack, NY 117255009 | 6313718034 | 6318287899 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578052866 | Matthew Robert Wagner | Dentist | 2830 Curry Ln #1, Green Bay, WI 54311 | 2018-05-02 |
| 1538534334 | Matthew Wagner | Acupuncturist | 4513 Vernon Blvd, Madison, WI 53705-4993 | 2015-12-04 |
| 1053749168 | Matthew Wagner | Counselor | 545 N Mcdonough St Ste 212, Decatur, GA 30030-3310 | 2013-10-29 |
| 1700415965 | Matthew Anthony Wagner | Student in an Organized Health Care Education/Training Program | 1500 E Sherman Blvd, Muskegon, MI 49444-1849 | 2020-04-08 |
| 1376177048 | Matthew Gary Wagner | Case Manager/Care Coordinator | 16 W Long St, Columbus, OH 43215-2815 | 2020-03-02 |
| 1235613738 | Matthew James Wagner | Pharmacist | 17213 Cole Rd, Hagerstown, MD 21740-6981 | 2018-09-20 |
| 1164918199 | Matthew Steven Wagner | Internal Medicine | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2018-07-02 |
| 1609371244 | Matthew Anthony Wagner | Student in an Organized Health Care Education/Training Program | 509 Biltmore Ave, Asheville, NC 28801-4601 | 2018-03-26 |
| 1669994752 | Matthew Wagner | Behavior Technician | 415 Medical Dr Ste D101, Bountiful, UT 84010-8905 | 2017-07-11 |
| 1174973432 | Matthew Wagner | Peer Specialist | 190 Match Factory Pl, Bellefonte, PA 16823-1367 | 2016-06-17 |
| Street Address |
1500 ROUTE 112 BLDG 2C |
| City | PORT JEFFERSON STATION |
| State | NY |
| Zip Code | 11776-8055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205304219 | Melissa E Germano | Acupuncturist | 5225 Nesconset Highway Rte 347, Davis Professional Park Building 1 Suite 1, Port Jefferson Station, NY 11776 | 2018-11-07 |
| 1366962185 | Michael Louis Scicchitano Sr. | Physical Therapist | 3 Colgate Street, Port Jefferson Station, NY 11776 | 2017-06-22 |
| 1063969517 | Dana Adamkiewicz | Acupuncturist | 432 North Bicycle Path, Port Jefferson Station, NY 11776 | 2016-09-01 |
| 1538531819 | Jacqueline Rambo | Specialist | 5225 Nesconset Highway Suite 30, Port Jefferson Station, NY 11776 | 2015-10-26 |
| 1821474297 | Michael Leuci | Social Worker | 3 Premier Court, Port Jefferson Station, NY 11776 | 2015-08-07 |
| 1578978078 | Carol A. Palmer I | Acupuncturist | 34 Champlain St, Port Jefferson Station, NY 11776 | 2014-06-24 |
| 1659783371 | Janette M Sperandeo | Nurse Practitioner | 5 Roosevelt Avenue, Port Jefferson Station, NY 11776 | 2014-05-29 |
| 1578973079 | James Buchrieser | Specialist | 525 Nesconset Highway Suite 30, Port Jefferson Station, NY 11776 | 2014-05-06 |
| 1871923227 | Duran Thomas Murphy | Licensed Practical Nurse | 8 Carolyn Road, Port Jefferson Station, NY 11776 | 2013-11-22 |
| 1699104562 | Julio Genao | Massage Therapist | 213 Jayne Blvd, Portjefferson Station, NY 11776 | 2013-11-01 |
| Find all providers in zip 11776 | ||||
| Taxonomy Code | 207XP3100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Pediatric Orthopaedic Surgery |
| An orthopedic surgeon who has additional training and experience in diagnosing, treating and managing musculoskeletal problems in infants, children and adolescents. These may include limb and spine deformities (such as club foot, scoliosis); gait abnormalities (limping); bone and joint infections; broken bones. |
| Notes: Source: American Academy of Pediatrics, www.aap.org [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689925372 | Advanced Orthopedics and Joint Preservation PC | Orthopaedic Surgery | 141 E Merrick Rd, Suite B, Valley Stream, NY 11580-5925 | 2012-09-21 |
| 1154689867 | Allison Brooke Spitzer | Orthopaedic Surgery | 7 Vermont Drive, Center for Pediatric Orthopaedic Surgery, New Hyde Park, NY 11042 | 2012-05-01 |
| 1023392354 | Wesley V. Carrion, Md PC | Orthopaedic Surgery | 1 Shore Dr, Setauket, NY 11733-1619 | 2011-10-05 |
| 1023238979 | David Richard Graham | Orthopaedic Surgery | 690 W Clinton St, Elmira, NY 14905-2226 | 2007-04-25 |
| 1629291612 | Leon Sultan | Orthopaedic Surgery | 255 Franklin Ave., Franklin Square, NY 07740-1436 | 2007-04-10 |
| 1316980428 | Richard I Ulin | Orthopaedic Surgery | 1095 Park Ave, New York, NY 10128-1154 | 2006-06-14 |
| 1720620149 | Christopher Ryan Chapman | Orthopaedic Surgery | 450 Clarkson Ave, Brooklyn, NY 11203-2012 | 2019-10-17 |
| 1437672623 | Karim Masrouha | Orthopaedic Surgery | 550 1st Ave, New York, NY 10016-6402 | 2017-07-20 |
| 1023564234 | Susan Elizabeth Nelson | Orthopaedic Surgery | 601 Elmwood Ave, Rochester, NY 14625 | 2016-08-28 |
| 1770931776 | Jenny Frances, LLC | Orthopaedic Surgery | 303 2nd Ave, Suite 19, New York, NY 10003-2739 | 2016-05-31 |
| Find all providers with the same taxonomy | ||||
| City | PORT JEFFERSON STATION |
| Zip Code | 11776 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.