Provider Demographics
NPI:1184147498
Name:ENID HOLDINGS LLC
Entity type:Organization
Organization Name:ENID HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ENID
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOCKUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-615-4832
Mailing Address - Street 1:14 PONY LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70087-3638
Mailing Address - Country:US
Mailing Address - Phone:202-615-4832
Mailing Address - Fax:
Practice Address - Street 1:4501 N I 10 SERVICE RD W
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6525
Practice Address - Country:US
Practice Address - Phone:202-615-4832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty