Pegasus DME Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

PEGASUS DME INC

Doing business as

National Brace

Practice address

80 Orville Dr Ste 100
Bohemia, NY 11716-2505

Phone

(516) 680-0433

Fax

(877) 366-5492

NPI assigned

Aug 19, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Affenita, CERTIFIED ORTHOTIST

Title

Ao

Phone

(516) 680-0433

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• National Brace Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629331200000",
    "number": "1053087064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "227 GILLETTE AVE",
            "city": "BAYPORT",
            "state": "NY",
            "postal_code": "117051881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 ORVILLE DR STE 100",
            "city": "BOHEMIA",
            "state": "NY",
            "postal_code": "117162505",
            "telephone_number": "516-680-0433",
            "fax_number": "877-366-5492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEGASUS DME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-07-13",
        "status": "A",
        "authorized_official_last_name": "AFFENITA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "516-680-0433",
        "authorized_official_credential": "CERTIFIED ORTHOTIST"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04998692",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "National Brace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Judith C. Para, R.N.
• Nidia Andrea Pardo Angel, MD
• Christina Pardo, MD, MPH
• Ekta M Patel, M.D.
• Monika Charlotte Paulus
• Kaitlyn Perea
• Michelle C. Pesca, PH.D.
• Peter Bourque NP LLC
• Lauren Petrelli, BA
• Pharmacy Solution Services LLC

• Prosthetic/Orthotic Supplier in Bohemia, NY
• Providers in Bohemia, NY by specialty
• Prosthetic/Orthotic Supplier in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.