Elly Wagner, PA-C

NPI #1629859426 in Kingston, New York

Provider Information

NPI Number: 1629859426
Entity Type: Individual
Name: Elly Wagner, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Oct 9, 2023
Last Updated: Oct 9, 2023

Practice Location

Address: 373 BROADWAY
City: Kingston
State: New York
ZIP Code: 12401-5151
Phone: (845) 303-1132

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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