Healthcare Provider Details

I. General information

NPI: 1538802863
Provider Name (Legal Business Name): 360 MEDICAL CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E 58TH ST FL 15
NEW YORK NY
10022-1236
US

IV. Provider business mailing address

133 E 58TH ST FL 15
NEW YORK NY
10022-1236
US

V. Phone/Fax

Practice location:
  • Phone: 212-813-9450
  • Fax: 860-246-7688
Mailing address:
  • Phone: 212-751-8300
  • Fax: 212-813-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NYDIA CASTILLO
Title or Position: BILLING MANAGER
Credential:
Phone: 860-246-7668