| Organization Name: | JEROME E. BAGNER, DPM, P.C. |
| NPI Number: | 1003160292 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEROME E BAGNER (PRESIDENT) |
| Mailing Address: | 30 Hempstead Ave Suite 158 Rockville Centre |
| State: | NY US |
| Postal Code: | 115704033 |
| Phone Number: | 5167646800 |
| Fax Number: | 5167647047 |
| NPI Enumeration Date: | 11/09/2012 |
| NPI Last Update Date: | 11/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | N002233-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |