Provider Demographics
NPI:1376806752
Name:ALLIE, TOMMY RICHARD (SI)
Entity Type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:RICHARD
Last Name:ALLIE
Suffix:
Gender:M
Credentials:SI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 WARBURTON AVE
Mailing Address - Street 2:APT.2B
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1605
Mailing Address - Country:US
Mailing Address - Phone:914-552-9448
Mailing Address - Fax:
Practice Address - Street 1:710 WARBURTON AVE
Practice Address - Street 2:APT.2B
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1605
Practice Address - Country:US
Practice Address - Phone:914-552-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY771937174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist