Provider Demographics
NPI:1184653776
Name:ALI, EYAD M (MD)
Entity Type:Individual
Prefix:DR
First Name:EYAD
Middle Name:M
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 W MONTAUK HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-3551
Mailing Address - Country:US
Mailing Address - Phone:631-723-0600
Mailing Address - Fax:631-723-0003
Practice Address - Street 1:332 W MONTAUK HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-3551
Practice Address - Country:US
Practice Address - Phone:631-723-0600
Practice Address - Fax:631-723-0003
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212118207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02110052Medicaid
NY02110052Medicaid
NY27B801Medicare ID - Type Unspecified