Provider First Line Business Practice Location Address:
462 FIRST AVENUE
Provider Second Line Business Practice Location Address:
BELLEVUE NYU PSOT, BELLEVUE HOSPTIAL CENTER, CD 738
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-994-7162
Provider Business Practice Location Address Fax Number:
212-994-7177
Provider Enumeration Date:
12/19/2006