DR. JACK WALTER CARL HAGSTROM


Address: 876, Seven Ponds Towd Road, Water Mill, NY 11976
Phone: 6317265914

DR. JACK WALTER CARL HAGSTROM (NPI# 1982040176) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1982040176
Entity Type Individual
Full Name DR. JACK WALTER CARL HAGSTROM
Credential M.D.
Practice Address 876, Seven Ponds Towd Road
Water Mill
NY 11976
Mailing Address P.o. Box 105
876, Seven Ponds Towd Road
Water Mill
NY 11976
Practice Telephone 6317265914
Mailing Telephone 6317265914
Enumeration Date 2013-05-15
Last Update Date 2013-05-15
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207ZP0101X Pathology
Specialization: Anatomic Pathology
084559-1 NY Allopathic & Osteopathic Physicians

Office Location

Street Address 876, SEVEN PONDS TOWD ROAD
City WATER MILL
State NY
Zip Code 11976

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1447745062 Richard M. Lawless Counselor 860 Montauk Highway, Building 1, Water Mill, NY 11976 2018-06-26
1093009003 Liane Hayward Physical Therapist 70 Scuttle Hole Road, Water Mill, NY 11976 2011-06-07
1437374840 Joanne Mercer Podiatrist 708 Montauk Hwy, Water Mill, NY 11976 2007-04-13
1679608004 Kaye Wilson Family Medicine 1320 Montauk Hwy, Watermill, NY 11976 2007-02-23
1215032297 Damian A Marrese Family Medicine 860 Montauk Hwy, #247, Water Mill, NY 11976-0247 2006-09-14
1619272408 Gertrud Elisabeth Hoertnagl-pereira Occupational Therapist 262 Roses Grove Rd, Water Mill, NY 11976-2034 2011-01-25
1285996173 Pamela Ann Wittenberg Specialist 472 Blank Ln, Water Mill, NY 11976-2136 2012-06-15
1922423847 Anthony Lombardo Registered Nurse 32 Deer Run, Water Mill, NY 11976-2144 2014-02-28
1619489531 Nicole Elizabeth Gambino Specialist 35 Winding Way, Water Mill, NY 11976-2325 2017-11-01
1912330630 Anna Silverberg Nurse Practitioner 16 Fairbanks Ct, Water Mill, NY 11976-2340 2013-08-16
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Taxonomy Information

Taxonomy Code 207ZP0101X
Grouping Allopathic & Osteopathic Physicians
Classification Pathology
Specialization Anatomic Pathology

Taxonomy Definition

A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
Notes: Source: American Board of Medical Specialties, 2007. [7/1/2007: definition added, source added, 7/1/2009: defintion reformatted; 7/1/2011: modified source]
- Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/. American Osteopathic Board of Pathology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology (note: this taxonomy code identifies the "anatomic pathology only" route). To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications.

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1225649445 Ben Bristol Pathology 424 Manville Rd Apt 2, Pleasantville, NY 10570-2848 2020-08-11
1548879802 Vanguard Medical Services Pllc Pathology 233 Broadway Rm 2750, New York, NY 10279-2704 2020-07-23
1376164541 Iftikhar Butt Pathology 17 Stablegate Dr, Clifton Park, NY 12065-6796 2020-04-29
1699395392 Farah Malek Pathology 51 Heritage Point Drvie, Clifton Park, NY 12065 2020-04-22
1902436728 Coney Island Medical Diagnostic Services P C Pathology 1704 Mermaid Ave Ste 6, Brooklyn, NY 11224-2622 2020-01-21
1821527680 Gamaliel Immanuel Medical Services PC Pathology 230 Hilton Ave Ste 214, Hempstead, NY 11550-8116 2017-06-06
1639605991 New York Medical and Diagnostic Services PC Pathology 2315 86th St Fl 1, Brooklyn, NY 11214-4309 2017-05-05
1902355415 Jayne Elizabeth Kremzier Pathology 349 Reist St, Williamsville, NY 14221-5344 2016-09-26
1336509090 Joseph C Segen Pathology 1 Hawthorne Ln, Manhasset, NY 11030-1505 2016-02-24
1386061133 Lee J. Slavutin Pathology 100 Riverside Drive, Apt 15d, New York, NY 10024 2014-03-18
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Competitor

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City WATER MILL
Zip Code 11976

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Dataset Information

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.

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