| | Physician Last Name: | Wagner |
| | Physician First Name: | Jack |
| | Physician Middle Name: | |
| | Address: | 37 Wilputte Place
New Rochelle, New York 10804 |
| | License Number: | 090773 |
| | License Type: | MD |
| | Year of Birth: |
1937
|
| | Effective Date: | 04/27/2000 |
| | Action Description for DOH Webpage: | License permanently limitation precluding the practice of medicine and prohibiting the physician from serving as a medical director of any medical facility |
| | Misconduct Description for DOH Webpage: | The physician did not contest the charge of negligence on more than one occasion |
| | License Limitations or Conditions for DOH Webpage: | The physician's license is permanently limited precluding any practice of medicine and prohibiting the physician from serving as a medical director for any medical facility. |
| | Board Order: |
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