Healthcare Provider Details

I. General information

NPI: 1003278680
Provider Name (Legal Business Name): ANDREW JOSEPH BELLANTONI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SKYLINE DR STE 800S
HAWTHORNE NY
10532-2134
US

IV. Provider business mailing address

19 SKYLINE DR STE 1N-H15
HAWTHORNE NY
10532-2134
US

V. Phone/Fax

Practice location:
  • Phone: 914-594-2150
  • Fax:
Mailing address:
  • Phone: 914-594-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number315024-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: