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General NPI Number Information
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NPI Number | 1649087263
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Entity Type | Organization
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Legal Business Name | NC MEDICAL OF NY PC
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 201 MONARCH DR
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City | LIVERPOOL
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State | NY
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Zip | 13088-4506
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Country | US
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Telephone | 315-615-4464
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Fax |
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Provider Business Mailing Address
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Address Line | 10 W MARKET ST STE 2900
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-2964
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Country | US
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Telephone | 866-434-3255
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Fax |
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Authorized Official
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Title or Position | CENTRAL SUPPORT SPECIALIST
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Name | RILEY WENDLING
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Credential |
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Telephone | 629-266-1080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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