MEDICARE: SAMANTHA KHITROV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1992638175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA KHITROV

Provider Business Mailing Address
First Line	:	8 MOUNTAINVIEW AVE
Second Line	:
City	:	ARDSLEY
State	:	NY
Zip	:	10502-1904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 LENOX AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4991
Country	:	US
Telephone Number	:	332-297-7824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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