Provider Demographics
NPI:1508178179
Name:PEGO, KRISTIN DEBRA (NP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DEBRA
Last Name:PEGO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:DEBRA
Other - Last Name:JANSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:160 E 34TH ST
Mailing Address - Street 2:NYU CLINICAL CANCER CENTER, 3RD FLOOR ROOM 316
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4744
Mailing Address - Country:US
Mailing Address - Phone:212-731-5366
Mailing Address - Fax:212-731-6051
Practice Address - Street 1:160 E 34TH ST
Practice Address - Street 2:NYU CLINICAL CANCER CENTER THIRD FLOOR ROOM 316
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4744
Practice Address - Country:US
Practice Address - Phone:212-731-5366
Practice Address - Fax:212-531-6061
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305431-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health