MEDICARE: DR. MATTHEW FANOUS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	318774	NY
2	207RC0000X	Cardiovascular Disease Physician	318774	NY

General Provider Information

NPI Number	:	1841759859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW FANOUS MD

Provider Business Mailing Address
First Line	:	2651 STRANG BLVD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-2940
Country	:	US
Telephone Number	:	914-849-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2651 STRANG BLVD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-2940
Country	:	US
Telephone Number	:	914-849-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	01/06/2026

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