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General NPI Number Information
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NPI Number | 1326033572
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Entity Type | Individual
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Provider Name | CRAIG R WAGNER DO ANESTHESIOLOGIST
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Gender | Male
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 509 N BROAD ST UNDERWOOD HOSP
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City | WOODBURY
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State | NJ
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Zip | 08096
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Country | US
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Telephone | 856-845-5836
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Fax |
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Provider Business Mailing Address
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Address Line | 509 N BROAD ST
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City | WOODBURY
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State | NJ
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Zip | 08096-1617
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Country | US
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Telephone | 856-845-0100
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Fax | 856-848-7023
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MB05214300
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License Number State | NJ
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