Provider Demographics
NPI:1366750085
Name:PEGUS, CRYSTAL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:PEGUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E 19TH ST
Mailing Address - Street 2:APT D4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4470
Mailing Address - Country:US
Mailing Address - Phone:347-278-2154
Mailing Address - Fax:
Practice Address - Street 1:50 E 19TH ST
Practice Address - Street 2:APT D4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4470
Practice Address - Country:US
Practice Address - Phone:347-278-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY556878163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool