Provider First Line Business Practice Location Address:
NY INST OF TECHNOLOGY NORTHERN BLVD
Provider Second Line Business Practice Location Address:
ACADEMIC HEALTH CARE CENTER
Provider Business Practice Location Address City Name:
OLD WESTBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11568-0210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-686-1300
Provider Business Practice Location Address Fax Number:
516-686-7890
Provider Enumeration Date:
11/25/2006