Individual
DR. CLARICIO DECASTRO PEGUERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
506 LENOX AVENUE, 3RD FLOOR MLK BLDG / PAIN MANAGEMENT CLINIC, NEW YORK, NY 10037-1802
(212) 939-1000
(212) 939-2068
Mailing address
154 ORANGEBURGH RD, OLD TAPPAN, NJ 07675-7499
(551) 204-2543
(212) 939-2068
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
206656
NY
207LP2900X
Pain Medicine (Anesthesiology) Physician
206656
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02060277
—
NY
Enumeration date
07/28/2006
Last updated
01/26/2022
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