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General NPI Number Information
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NPI Number | 1780976639
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Entity Type | Organization
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Legal Business Name | TWIN FORKS MEDICAL PC
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 332 W MONTAUK HWY SUITE 1
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City | HAMPTON BAYS
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State | NY
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Zip | 11946-3551
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Country | US
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Telephone | 631-723-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 332 W MONTAUK HWY SUITE 1
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City | HAMPTON BAYS
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State | NY
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Zip | 11946-3551
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Country | US
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Telephone | 631-723-0600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EYAD ALI
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Credential | M.D.
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Telephone | 631-728-1128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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