Provider Demographics
NPI:1649736661
Name:KHALIFE, SAMARI
Entity Type:Individual
Prefix:
First Name:SAMARI
Middle Name:
Last Name:KHALIFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 LONGSTREET AVE APT 4C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-3758
Mailing Address - Country:US
Mailing Address - Phone:347-819-0109
Mailing Address - Fax:
Practice Address - Street 1:270 LONGSTREET AVE APT 4C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-3758
Practice Address - Country:US
Practice Address - Phone:347-819-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program