| Doctor Name: | EDWARD PEGUERO |
| NPI Number: | 1588953293 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ORTHOTIST |
| License Number: | |
| Business Practice Address: | 8211 37th Avenue Suite Ll19 Jackson Heights, NY - 11372 |
| Business Phone Number: | 7182551986 |
| Business Fax Number: | 7182551989 |
| Mailing Address: | 20911 41st Ave, BAYSIDE |
| State: | NY |
| Postal Code: | 113611926 |
| Phone Number: | 5515802711 |
| Fax Number: | 7182255374 |
| NPI Enumeration Date: | 04/04/2011 |
| NPI Last Update Date: | 05/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |