Provider Demographics
NPI:1093006652
Name:OSMAN-WAGER, JAMIE LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LAUREN
Last Name:OSMAN-WAGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 KOSSUTH AVE
Mailing Address - Street 2:FAMILY CARE CENTER, 5TH FLOOR, PAA
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2410
Mailing Address - Country:US
Mailing Address - Phone:718-920-2273
Mailing Address - Fax:
Practice Address - Street 1:3444 KOSSUTH AVE
Practice Address - Street 2:FAMILY CARE CENTER, 5TH FLOOR, PAA
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2410
Practice Address - Country:US
Practice Address - Phone:718-920-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine