Healthcare Provider Details

I. General information

NPI: 1174717623
Provider Name (Legal Business Name): TWIN FORKS SURGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 W MONTAUK HWY SUITE 3
HAMPTON BAYS NY
11946-3551
US

IV. Provider business mailing address

332 W MONTAUK HWY SUITE 3
HAMPTON BAYS NY
11946-3551
US

V. Phone/Fax

Practice location:
  • Phone: 631-728-0393
  • Fax: 631-728-0394
Mailing address:
  • Phone: 631-728-0393
  • Fax: 631-728-0394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number216059
License Number StateNY

VIII. Authorized Official

Name: DR. STEVEN P OUZOUNIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 631-728-9360