Provider Demographics
NPI:1972977635
Name:THE TOMMY EXPERIENCE
Entity Type:Organization
Organization Name:THE TOMMY EXPERIENCE
Other - Org Name:TOMMY HOUSE SOCIAL DAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-488-3898
Mailing Address - Street 1:27 E MERRICK RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5814
Mailing Address - Country:US
Mailing Address - Phone:917-488-3898
Mailing Address - Fax:
Practice Address - Street 1:27 E MERRICK RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5814
Practice Address - Country:US
Practice Address - Phone:917-488-3898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care