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DR. MATTHEW ROBERT WAGNER MD
NPI 1114198751
Orthopaedic Surgery - Pediatric Orthopaedic Surgery in Port Jefferson Station, NY

Active since March 21, 2008PECOS Enrolled
1500 ROUTE 112 BLDG 2C, PORT JEFFERSON STATION, NY 11776(631) 371-8034(631) 828-7899 Get Directions Write a Review

NPPES record last updated: November 5, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. Matthew Robert Wagner Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MATTHEW ROBERT WAGNER MD (NPI 1114198751) is an individual pediatric orthopaedic surgery provider in Port Jefferson Station, New York, licensed in New York (251727) and active in the NPI registry since March 2008. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1114198751
Entity TypeIndividualMale
Primary Taxonomy207XP3100X
Provider Legal NameDR. MATTHEW ROBERT WAGNERCredential: MD
Location Address1500 ROUTE 112 BLDG 2CPort Jefferson Station, NY 11776-8055
Mailing Address1500 Route 112 Bldg 2cPort Jefferson Station, NY 11776-8055 · (631) 371-8034 · Fax (631) 828-7899
Phone(631) 371-8034
Fax(631) 828-7899
Sole ProprietorYes
Enumeration DateMarch 21, 2008
Last NPPES UpdateNovember 5, 2019
✔ NPI 1114198751 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic Surgery · Pediatric Orthopaedic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207XP3100X
Licenses✔ Licensed in NY · 251727✔ Licensed in FL · ME103612
Definition
An orthopedic surgeon who has additional training and experience in diagnosing, treating and managing musculoskeletal problems in infants, children and adolescents. These may include limb and spine deformities (such as club foot, scoliosis); gait abnormalities (limping); bone and joint infections; broken bones.
1500 ROUTE 112 BLDG 2C, Port Jefferson Station, NY 11776
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Other Identifiers 1

Other120130521000407NY · Medicare

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Matthew Robert Wagner Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LIDIA ANI
Orthopaedic Surgery (Adult Reconstructive Orthopaedic Surgery)
1500 ROUTE 112 BLDG 2C
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 828-7220

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Matthew Wagner's NPI number?

The NPI number for Matthew Wagner is 1114198751. It was assigned to this individual provider in the NPPES registry on March 21, 2008.

Where is Matthew Wagner located?

Matthew Wagner practices at 1500 Route 112 Bldg 2C, Port Jefferson Station, NY 11776. The listed phone number is (631) 371-8034.

What is Matthew Wagner's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery, specializing in Pediatric Orthopaedic Surgery, with taxonomy code 207XP3100X.

Is Matthew Wagner enrolled in Medicare?

Yes. Matthew Wagner is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Matthew Wagner was last updated on November 5, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.