Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Matthew Robert Wagner, MD

Individual provider Pediatric Orthopaedic Surgery Physician · NPI 1114198751

Dr. Matthew Robert Wagner, MD is a Pediatric Orthopaedic Surgery Physician in Port Jefferson Station, New York. Practices as a sole proprietor and works from 2 locations. Licensed in Florida and New York.

Licensed in
FL, NY
In the registry since
2008
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1500 Route 112 Bldg 2C
Port Jefferson Station, NY 11776-8055
Phone: (631) 371-8034
Fax: (631) 828-7899
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 500 Commack Rd Unit 150, Commack, NY 11725-5009 — (631) 371-8034

Specialties & licences

Pediatric Orthopaedic Surgery Physician (primary) Taxonomy 207XP3100X · Licence 251727 (NY)
Pediatric Orthopaedic Surgery Physician Taxonomy 207XP3100X · Licence ME103612 (FL)

Record details

NPI number1114198751
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedMarch 21, 2008
Last updated in NPPESNovember 5, 2019