Provider First Line Business Practice Location Address:
410 LAKEVILLE RD SUITE 105
Provider Second Line Business Practice Location Address:
NS-LIJ COHEN CHILDREN'S MEDICAL CENTER OF NY
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-465-5255
Provider Business Practice Location Address Fax Number:
718-347-2240
Provider Enumeration Date:
11/30/2006