Healthcare Provider Details

I. General information

NPI: 1053067546
Provider Name (Legal Business Name): FLYING 3SIXTY NAX, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 BEACH 47TH ST APT 2
FAR ROCKAWAY NY
11691-1119
US

IV. Provider business mailing address

432 BEACH 47TH ST APT 2
FAR ROCKAWAY NY
11691-1119
US

V. Phone/Fax

Practice location:
  • Phone: 718-688-5154
  • Fax: 347-619-5538
Mailing address:
  • Phone: 718-688-5154
  • Fax: 347-619-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: NATASHA CARTER
Title or Position: EXECUTIVE OFFICER
Credential:
Phone: 718-688-5154