Provider First Line Business Practice Location Address: 
1901 FIRST AVENUE METROPOLITAN HOSPITAL CENTER
    Provider Second Line Business Practice Location Address: 
PEDIATRIC DEPARTMENT
    Provider Business Practice Location Address City Name: 
NEW YORK
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
10029
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
212-423-6228
    Provider Business Practice Location Address Fax Number: 
212-423-7697
    Provider Enumeration Date: 
12/06/2006