Provider Demographics
NPI:1144104886
Name:NC MEDICAL OF NY PC
Entity type:Organization
Organization Name:NC MEDICAL OF NY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTRAL SUPPORT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WENDLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-266-1080
Mailing Address - Street 1:PO BOX 1433
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03802-1433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 N JENSEN RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2141
Practice Address - Country:US
Practice Address - Phone:866-434-3255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care