Provider Demographics
NPI:1700405818
Name:KHAITOV, ARIELLA KASHI (MD)
Entity Type:Individual
Prefix:DR
First Name:ARIELLA
Middle Name:KASHI
Last Name:KHAITOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARIELLA
Other - Middle Name:
Other - Last Name:KASHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10 MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1107
Mailing Address - Country:US
Mailing Address - Phone:732-239-0399
Mailing Address - Fax:
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-493-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME162861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program