Provider First Line Business Practice Location Address: 
THE MOUNT SINAI HOSPITAL
    Provider Second Line Business Practice Location Address: 
1468 MADISON AVENUE
    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: 
212-996-2230
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/01/2020