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NPI Code Detail

MEDICARE: SAMSON BALAKHANI

MEDICARE: SAMSON BALAKHANI
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
1390200000XStudent in an Organized Health Care Education/Training ProgramNY

General Provider Information

NPI Number : 1558299503
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMSON BALAKHANI
Provider Business Mailing Address
First Line : 35 KEATS LN
Second Line :
City : GREAT NECK
State : NY
Zip : 11023-1817
Country : US
Telephone Number : 516-418-9614
Fax Number :
Provider Business Practice Location Address
First Line : 451 CLARKSON AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2054
Country : US
Telephone Number : 718-245-4914
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2026
Last Update Date : 05/11/2026

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Directions to “ SAMSON BALAKHANI ” Practice Location

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