Provider Demographics
NPI:1780976639
Name:TWIN FORKS MEDICAL PC
Entity type:Organization
Organization Name:TWIN FORKS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-728-1128
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty