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General NPI Number Information
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NPI Number | 1003160292
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Entity Type | Organization
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Legal Business Name | JEROME E. BAGNER, DPM, P.C.
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Dates
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Enumeration Date | 11/09/2012
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Last Update Date | 11/09/2012
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Provider Practice Location Address
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Address Line | 30 HEMPSTEAD AVE SUITE 158
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4033
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Country | US
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Telephone | 516-764-6800
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Fax | 516-764-7047
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Provider Business Mailing Address
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Address Line | 30 HEMPSTEAD AVE SUITE 158
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4033
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Country | US
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Telephone | 516-764-6800
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Fax | 516-764-7047
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEROME E BAGNER
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Credential | DPM
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Telephone | 516-764-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N002233-1
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License Number State | NY
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