Healthcare Provider Details

I. General information

NPI: 1649838640
Provider Name (Legal Business Name): ALTHEA MARIE FERNANDEZ DIAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 NY 312 SOUTHEAST EXECUTIVE PARK
BREWSTER NY
10509
US

IV. Provider business mailing address

185 ROUTE 312
BREWSTER NY
10509-2337
US

V. Phone/Fax

Practice location:
  • Phone: 845-278-7000
  • Fax:
Mailing address:
  • Phone: 845-278-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number316128
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number316128
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: