Provider Demographics
NPI:1730498783
Name:WAGNER, JOSH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSH
Middle Name:
Last Name:WAGNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E 71ST ST
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 E 71ST ST
Practice Address - Street 2:SUITE 5A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4119
Practice Address - Country:US
Practice Address - Phone:843-323-8853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor