Provider Demographics
NPI:1053363168
Name:TLC MEDICAL CLINIC
Entity type:Organization
Organization Name:TLC MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOCILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-226-0755
Mailing Address - Street 1:14 MOUNTAIN LEDGE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILTON
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1858
Mailing Address - Country:US
Mailing Address - Phone:518-226-0755
Mailing Address - Fax:518-226-0758
Practice Address - Street 1:14 MOUNTAIN LEDGE
Practice Address - Street 2:SUITE 2
Practice Address - City:WILTON
Practice Address - State:NY
Practice Address - Zip Code:12831-1858
Practice Address - Country:US
Practice Address - Phone:518-226-0755
Practice Address - Fax:518-226-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196889170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty