Healthcare Provider Details

I. General information

NPI: 1457265514
Provider Name (Legal Business Name): CHAYA COUSIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 CLARKSON AVE
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

681 CROWN ST
BROOKLYN NY
11213-5303
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-4580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number361058
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: