Healthcare Provider Details

I. General information

NPI: 1144104886
Provider Name (Legal Business Name): NC MEDICAL OF NY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N JENSEN RD
VESTAL NY
13850-2141
US

IV. Provider business mailing address

PO BOX 1433
PORTSMOUTH NH
03802-1433
US

V. Phone/Fax

Practice location:
  • Phone: 866-434-3255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RILEY WENDLING
Title or Position: CENTRAL SUPPORT SPECIALIST
Credential:
Phone: 629-266-1080