Provider First Line Business Practice Location Address:
1051 RIVERSIDE DR
Provider Second Line Business Practice Location Address:
NEW YORK STATE PSYCHIATRIC INSTITUTE, UNIT 31, RM 6110
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10032-1007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-774-8123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2010