Provider First Line Business Practice Location Address:
353 E 17TH ST, 2ND FL 2, RM 223
Provider Second Line Business Practice Location Address:
BETH ISRAEL MED CTR, DEPT OF PSYCH
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-3804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-420-3743
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2014