Provider Demographics
NPI:1295930113
Name:360 KNICKER CORP
Entity type:Organization
Organization Name:360 KNICKER CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:IVELISSE
Authorized Official - Middle Name:CARIDAD
Authorized Official - Last Name:CHARLOTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-426-7151
Mailing Address - Street 1:360 KNICKERBOCKER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-3751
Mailing Address - Country:US
Mailing Address - Phone:718-455-1301
Mailing Address - Fax:718-455-1375
Practice Address - Street 1:360 KNICKERBOCKER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-3751
Practice Address - Country:US
Practice Address - Phone:718-455-1301
Practice Address - Fax:718-455-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty