Healthcare Provider Details

I. General information

NPI: 1295361236
Provider Name (Legal Business Name): ANDREW SANTOS FONTES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 ROUTE 312 STE 303
BREWSTER NY
10509-2338
US

IV. Provider business mailing address

185 ROUTE 312 STE 303
BREWSTER NY
10509-2338
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 Code208000000X
TaxonomyPediatrics Physician
License Number321656
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: