Provider Demographics
NPI:1851406961
Name:TWIN TIER ORTHOPEDIC & HAND SURGERY PC
Entity Type:Organization
Organization Name:TWIN TIER ORTHOPEDIC & HAND SURGERY PC
Other - Org Name:FAROUQ AL-KHALIDI MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAROUQ
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KHALIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-729-6226
Mailing Address - Street 1:4500 OLD VESTAL ROAD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:607-729-6226
Mailing Address - Fax:607-729-6227
Practice Address - Street 1:4500 OLD VESTAL ROAD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-729-6226
Practice Address - Fax:607-729-6227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1007951207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Not Answered207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00607754Medicaid
B81044Medicare UPIN
NY34551BMedicare ID - Type Unspecified