Healthcare Provider Details

I. General information

NPI: 1841759859
Provider Name (Legal Business Name): MATTHEW FANOUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3379 CROMPOND RD
YORKTOWN HEIGHTS NY
10598-3669
US

IV. Provider business mailing address

3379 CROMPOND RD
YORKTOWN HEIGHTS NY
10598-3669
US

V. Phone/Fax

Practice location:
  • Phone: 914-849-7060
  • Fax:
Mailing address:
  • Phone: 914-849-7060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number318774
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number318774
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: