Provider First Line Business Practice Location Address:
1981 MARCUS AVENUE
Provider Second Line Business Practice Location Address:
SUITE C-102 NYU CHILD STUDY CENTER
Provider Business Practice Location Address City Name:
LAKE SUCCESS
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:
516-358-1808
Provider Business Practice Location Address Fax Number:
646-754-9854
Provider Enumeration Date:
08/29/2007