Provider Demographics
NPI:1003259532
Name:WENGERTER, SEAN PATRICK (MD, RPVI)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PATRICK
Last Name:WENGERTER
Suffix:
Gender:M
Credentials:MD, RPVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5A MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3516
Mailing Address - Country:US
Mailing Address - Phone:845-362-0075
Mailing Address - Fax:
Practice Address - Street 1:5A MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:845-362-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA102551002086S0129X
390200000X
NY276619-12086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program