Healthcare Provider Details

I. General information

NPI: 1942910294
Provider Name (Legal Business Name): LORI WAGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date: 02/15/2023
Reactivation Date: 08/21/2026

III. Provider practice location address

72 FARMEDGE RD
LEVITTOWN NY
11756-5202
US

IV. Provider business mailing address

35 CARLTON AVE APT 2
PORT WASHINGTON NY
11050-3191
US

V. Phone/Fax

Practice location:
  • Phone: 516-490-3301
  • Fax:
Mailing address:
  • Phone: 843-283-7759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: