Provider Demographics
NPI:1659362838
Name:LEGASTO, ALAN CLINT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:CLINT
Last Name:LEGASTO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:575 LEXINGTON AVE STE 500
Mailing Address - Street 2:NEWYORK-PRESBYTERIAN-WCMC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6102
Mailing Address - Country:US
Mailing Address - Phone:212-746-6000
Mailing Address - Fax:646-962-0122
Practice Address - Street 1:525 E 68TH ST # 141
Practice Address - Street 2:NEWYORK-PRESBYTERIAN-WCMC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-6000
Practice Address - Fax:646-962-0122
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2232872085R0202X
NY2420922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02833205Medicaid
MA2103753Medicaid
MA468386OtherTUFTS HEALTH PLAN
MAJ28655OtherBCBS MA
I32447Medicare UPIN
MAA38541Medicare ID - Type Unspecified
NY887T61Medicare PIN