Provider Demographics
NPI:1033363635
Name:SHIFRIN, SAMANTHA RORI (MSED)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RORI
Last Name:SHIFRIN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:JANKOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSED
Mailing Address - Street 1:3040 JUDITH DR
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5328
Mailing Address - Country:US
Mailing Address - Phone:212-988-0936
Mailing Address - Fax:212-988-0936
Practice Address - Street 1:3040 JUDITH DR
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5328
Practice Address - Country:US
Practice Address - Phone:516-728-5142
Practice Address - Fax:212-988-0936
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY812042251S00000X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No251S00000XAgenciesCommunity/Behavioral Health