Provider Demographics
NPI:1568874782
Name:KHMARA, KSENIYA (MD)
Entity Type:Individual
Prefix:
First Name:KSENIYA
Middle Name:
Last Name:KHMARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PERONA LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3323
Mailing Address - Country:US
Mailing Address - Phone:646-239-2075
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - Street 2:STONY BROOK UNIVERSITY HOSPITAL HSC 4
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8480
Practice Address - Country:US
Practice Address - Phone:631-444-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT64068207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program