Healthcare Provider Details

I. General information

NPI: 1689989964
Provider Name (Legal Business Name): JUAN MANUEL ORTEGA LEGASPI MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRACE RD STE C2
CHERRY HILL NJ
08034-2600
US

IV. Provider business mailing address

301 LIPPINCOTT DR
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-482-8900
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD462128
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberMD462128
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number25MA12723500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: