Provider Demographics
NPI:1053067546
Name:FLYING 3SIXTY NAX, INC.
Entity Type:Organization
Organization Name:FLYING 3SIXTY NAX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-688-5154
Mailing Address - Street 1:432 BEACH 47TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1119
Mailing Address - Country:US
Mailing Address - Phone:718-688-5154
Mailing Address - Fax:347-619-5538
Practice Address - Street 1:432 BEACH 47TH ST APT 2
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1119
Practice Address - Country:US
Practice Address - Phone:718-688-5154
Practice Address - Fax:347-619-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date: