Healthcare Provider Details

I. General information

NPI: 1871402545
Provider Name (Legal Business Name): CORA Y KHAYTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 CROWN ST FL 2
BROOKLYN NY
11213-5424
US

IV. Provider business mailing address

731 CROWN ST FL 2
BROOKLYN NY
11213-5424
US

V. Phone/Fax

Practice location:
  • Phone: 347-526-3335
  • Fax:
Mailing address:
  • Phone: 347-526-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number018525
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: