Provider First Line Business Practice Location Address:
260-05, 76TH AVENUE
Provider Second Line Business Practice Location Address:
NORTH SHORE LONG ISLAND JEWISH HEALTH SYSTEM
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-470-7870
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2010