Provider First Line Business Practice Location Address:
5 E 98TH ST, # 1259
Provider Second Line Business Practice Location Address:
MOUNT SINAI MEDICAL CENTER--FACULTY PRACTICE ASSOCIATES
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-6574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-241-1657
Provider Business Practice Location Address Fax Number:
212-202-4703
Provider Enumeration Date:
10/19/2006