Healthcare Provider Details

I. General information

NPI: 1770653123
Provider Name (Legal Business Name): ROBERT JOHN LEGGIADRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST ROOM 420
BRONX NY
10451-5504
US

IV. Provider business mailing address

557 WELLINGTON DR
WYCKOFF NJ
07481-1138
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5800
  • Fax: 718-579-4700
Mailing address:
  • Phone: 201-847-1374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number131122
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: