| Wagner Medical Pc | |
|
1400 Hooper Ave Ste 2 Toms River NJ 08753-2981 | |
| (844) 843-7279 | |
| Not Available |
| Full Name | Wagner Medical Pc |
|---|---|
| Speciality | Social Worker |
| Location | 1400 Hooper Ave Ste 2, Toms River, New Jersey |
| Authorized Official Name and Position | Tanya Roach (CHIEF ADMINISTRATIVE OFFICER) |
| Authorized Official Contact | 9703297161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wagner Medical Pc 1099 18th St Ste 2350 Denver CO 80202-1936 Ph: (844) 843-7279 | Wagner Medical Pc 1400 Hooper Ave Ste 2 Toms River NJ 08753-2981 Ph: (844) 843-7279 |
| NPI Number | 1235951187 |
|---|---|
| Provider Enumeration Date | 10/30/2024 |
| Last Update Date | 03/31/2025 |
| Certification Date | 03/31/2025 |
| Medicare PECOS PAC ID | 3476082660 |
|---|---|
| Medicare Enrollment ID | O20250203001924 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235951187 | NPI | - | NPPES |
| Provider Name | Debbie Chisolm |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518120351 PECOS PAC ID: 7315392347 Enrollment ID: I20231011003506 |
| Provider Name | Donald Hupp |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568654242 PECOS PAC ID: 6507950201 Enrollment ID: I20240916002782 |
| Provider Name | Earl Lewis |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1619332004 PECOS PAC ID: 4880116235 Enrollment ID: I20250314003231 |
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