Healthcare Provider Details

I. General information

NPI: 1659362838
Provider Name (Legal Business Name): ALAN CLINT LEGASTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST # 141 NEWYORK-PRESBYTERIAN-WCMC
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

575 LEXINGTON AVE STE 500 NEWYORK-PRESBYTERIAN-WCMC
NEW YORK NY
10022-6102
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-6000
  • Fax: 646-962-0122
Mailing address:
  • Phone: 212-746-6000
  • Fax: 646-962-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number223287
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number242092
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: