Provider Demographics
NPI:1194934653
Name:PEGUERO, ARIS RAFAEL
Entity type:Individual
Prefix:DR
First Name:ARIS
Middle Name:RAFAEL
Last Name:PEGUERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PIERREPONT ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2428
Mailing Address - Country:US
Mailing Address - Phone:718-243-1889
Mailing Address - Fax:718-222-1355
Practice Address - Street 1:43-22 50TH ST. STE 1C
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:718-424-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02163931Medicaid
NY02163931Medicaid