ELLIOTT JAY WAGNER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036120986

License Status

ACTIVE

Business

First Name

ELLIOTT

Middle

JAY

Last Name

WAGNER

Suffix

Business Name

ELLIOTT JAY WAGNER MD

Original Issue Date

05/22/2008

Effective Date

04/23/2023

Expiration Date

07/31/2026

City

NEW YORK

State

Zip

10065

Ever Disciplined

LastModifiedDate

09/29/2023