Provider First Line Business Practice Location Address: 
525 E. 68TH STREET
    Provider Second Line Business Practice Location Address: 
NEW YORK PRESBYTERIAN HOSPITAL
    Provider Business Practice Location Address City Name: 
NEW YORK
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
10021
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
212-746-5464
    Provider Business Practice Location Address Fax Number: 
212-746-8165
    Provider Enumeration Date: 
05/12/2009