Healthcare Provider Details

I. General information

NPI: 1629050851
Provider Name (Legal Business Name): ALEJANDRO DANIEL IGLESIAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

PO BOX 32889
HARTFORD CT
06150-2889
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6247
  • Fax:
Mailing address:
  • Phone: 212-420-4179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number237706
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number237706
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: