Basic Information
| Provider Information | |||||||||
| NPI: | 1124630975 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DISPATCHHEALTH NJ WAGNER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3455 RINGSBY CT STE 102 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802164923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204808088 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 TICE BLVD STE A35 | ||||||||
| Address2: | |||||||||
| City: | WOODCLIFF LAKE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076777681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035001518 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2020 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | WAGNER | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6142264921 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DISPATCHHEALTH NJ WAGNER PC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.