Active NPI
John Wagner, ATC
- Athletic Trainer
- Jersey City, NJ
National Provider Identifier
1386697019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 25MT00083700
- Practice address
- 35 Colgate St
Jersey City, NJ 07302-3307 - Phone
- (201) 547-2093
- NPI assigned
- May 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 25MT00083700 | NJ | Primary |
Addresses
Primary practice location
35 Colgate St
Jersey City, NJ 07302-3307
Mailing address
510 Washington St
Floor 2
Carlstadt, NJ 07072-1508
Phone (201) 245-5417
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MT00083700 | NJ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209427200000",
"number": "1386697019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 WASHINGTON ST",
"address_2": "FLOOR 2",
"city": "CARLSTADT",
"state": "NJ",
"postal_code": "070721508",
"telephone_number": "201-245-5417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35 COLGATE ST",
"city": "JERSEY CITY",
"state": "NJ",
"postal_code": "073023307",
"telephone_number": "201-547-2093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JOHN",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-17",
"last_updated": "2008-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NJ",
"license": "25MT00083700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jersey City, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.