Provider Demographics
NPI:1144902479
Name:PEGLER MORGAN, LYSA
Entity type:Individual
Prefix:
First Name:LYSA
Middle Name:
Last Name:PEGLER MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BANKS AVE APT 1138
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-6202
Mailing Address - Country:US
Mailing Address - Phone:516-652-7393
Mailing Address - Fax:
Practice Address - Street 1:100 BANKS AVE APT 1138
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-6202
Practice Address - Country:US
Practice Address - Phone:516-652-7393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0210195227174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist