Individual
IVELISE A PEGUERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CLINICAL LAB TECH
Contact information
Practice address
1901 1ST AVE RM 1208, NEW YORK, NY 10029-7491
(212) 423-6271
Mailing address
1901 1ST AVE RM 1208, NEW YORK, NY 10029-7491
(212) 423-6271
Taxonomy
Speciality
Code
Description
License number
State
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
Primary
002964-1
NY
Other
Enumeration date
04/04/2018
Last updated
04/04/2018
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