Organization
PEGASUS DME INC
Active
Other names
National Brace
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN AFFENITA CERTIFIED ORTHOTIST (AO)
(516) 680-0433
Entity
Organization
Contact information
Practice address
80 ORVILLE DR STE 100, BOHEMIA, NY 11716-2505
(516) 680-0433
(877) 366-5492
Mailing address
227 GILLETTE AVE, BAYPORT, NY 11705-1881
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04998692
—
NY
Enumeration date
08/19/2021
Last updated
08/19/2021
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