Provider Demographics
NPI:1194384081
Name:TKR INC
Entity Type:Organization
Organization Name:TKR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKOLANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MS SP ED
Authorized Official - Phone:631-662-6156
Mailing Address - Street 1:8 GRASSY POND DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4028
Mailing Address - Country:US
Mailing Address - Phone:631-662-6156
Mailing Address - Fax:
Practice Address - Street 1:8 GRASSY POND DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4028
Practice Address - Country:US
Practice Address - Phone:631-662-6156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1093077745OtherNPPES