MEDICARE: TLC MEDICAL CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170100000X	Ph.D. Medical Genetics	196889	NY

General Provider Information

NPI Number	:	1053363168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	14 MOUNTAIN LEDGE
Second Line	:	SUITE 2
City	:	WILTON
State	:	NY
Zip	:	12831-1858
Country	:	US
Telephone Number	:	518-226-0755
Fax Number	:	518-226-0758

Provider Business Practice Location Address
First Line	:	14 MOUNTAIN LEDGE
Second Line	:	SUITE 2
City	:	WILTON
State	:	NY
Zip	:	12831-1858
Country	:	US
Telephone Number	:	518-226-0755
Fax Number	:	518-226-0758

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FRANK J NOCILLA
Credential	:	M.D.
Telephone Number	:	518-226-0755

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/22/2020

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Directions to “TLC MEDICAL CLINIC ” Practice Location

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