Provider Demographics
NPI:1033087457
Name:WAGNER, DANE CHRISTOPHER (MT-BC)
Entity type:Individual
Prefix:
First Name:DANE
Middle Name:CHRISTOPHER
Last Name:WAGNER
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 JORALEMON ST UNIT 92
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1482
Mailing Address - Country:US
Mailing Address - Phone:201-895-3450
Mailing Address - Fax:
Practice Address - Street 1:725 JORALEMON ST UNIT 92
Practice Address - Street 2:UNIT 92
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1482
Practice Address - Country:US
Practice Address - Phone:201-895-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty