DIANE WAGNER

ISLIP, NY
NPI1194812164
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy207ZB0001X Pathology, Blood Banking & Transfusion Medicine
(Licence: NY  182713)
Additional Taxonomies207ZM0300X Pathology, Medical Microbiology
(Licence: NY  182713)
207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology
(Licence: NY  182713)
2084P0800X Psychiatry & Neurology, Psychiatry
(Licence: NY  182713)
Enumeration Date2006-10-09
Last Update Date2007-07-08
Business Address
-- DIANE WAGNER M.D.
43 SHEBAR DR
ISLIP, NY 11751-4409
Phone number: 631-581-1119
Mailing Address
-- DIANE WAGNER M.D.
43 SHEBAR DR
ISLIP, NY 11751-4409
Phone number: 631-581-1119