Healthcare Provider Details

I. General information

NPI: 1558541748
Provider Name (Legal Business Name): TWIN FORKS GASTROENTEROLOGY & HEPATOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 E MONTAUK HWY SUITE 1
HAMPTON BAYS NY
11946-1866
US

IV. Provider business mailing address

34 E MONTAUK HWY SUITE 1
HAMPTON BAYS NY
11946-1866
US

V. Phone/Fax

Practice location:
  • Phone: 631-723-0600
  • Fax: 631-723-0003
Mailing address:
  • Phone: 631-723-0600
  • Fax: 631-723-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number212118
License Number StateNY

VIII. Authorized Official

Name: DR. EYAD M ALI
Title or Position: PRES
Credential: MD
Phone: 631-723-0600