Provider First Line Business Practice Location Address:
550 FIRST AVE, 8S4-11
Provider Second Line Business Practice Location Address:
DEPT OF PEDIATRICS NYU SOM
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-562-2455
Provider Business Practice Location Address Fax Number:
212-562-5518
Provider Enumeration Date:
08/17/2006