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Dr. Matthew Robert Wagner, MD
Pediatric Orthopedic Surgery Physician in Port Jefferson Station, New York
NPI 1114198751

Matthew Robert Wagner is a Pediatric Orthopedic Surgery Physician based in Port Jefferson Station, NY and is specialized in Pediatric Orthopedic Surgery. Matthew Robert Wagner practices in Port Jefferson Station, NY and has the professional credentials of MD. The NPI Number for Matthew Robert Wagner is 1114198751 and holds a License No. ME103612 (New York).

The current practice location address for Matthew Robert Wagner is 1500 Route 112 Bldg 2C, Port Jefferson Station, NY and can be reached out via phone at 631-371-8034 and via fax at 631-828-7899.

Location: 1500 Route 112 Bldg 2C, Port Jefferson Station, NY, 11776-8055
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1114198751
Provider Name
Matthew Robert Wagner
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
1500 Route 112 Bldg 2C, Port Jefferson Station, NY, 11776-8055
Phone Number
631-371-8034
Fax Number
631-828-7899
Provider Enumeration Date
03/21/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
120130521000407 01 NY MEDICARE
institution
Provider Business Practice Location Address Details
Address
1500 Route 112 Bldg 2C
City
Port Jefferson Station
State
New York
Zip
11776-8055
Phone Number
631-371-8034
Fax Number
631-828-7899
person
Provider Business Mailing Address Details
Address
1500 Route 112 Bldg 2C
City
Port Jefferson Station
State
New York
Zip
11776-8055
Phone Number
631-371-8034
Fax Number
631-828-7899
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Orthopedic Surgery
Speciality
Pediatric Orthopedic Surgery
Taxonomy
207XP3100X
License No.
ME103612 (Florida)
Definition
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.
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