Provider Demographics
NPI:1992257034
Name:NC MEDICAL OF NY PC
Entity type:Organization
Organization Name:NC MEDICAL OF NY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VP CORPORATE MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:377-522-0844
Mailing Address - Street 1:10 W MARKET ST STE 2900
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2964
Mailing Address - Country:US
Mailing Address - Phone:802-857-0400
Mailing Address - Fax:
Practice Address - Street 1:1221 AVENUE OF THE AMERICAS RM 50073
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020-1001
Practice Address - Country:US
Practice Address - Phone:212-819-8955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NC MEDICAL OF NY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-25
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty