Provider First Line Business Practice Location Address:
1090 AMSTERDAM AVENUE SUITE 16A
Provider Second Line Business Practice Location Address:
MOUNT SINAI ST. LUKE'S
Provider Business Practice Location Address City Name:
NEW YORK CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-523-5089
Provider Business Practice Location Address Fax Number:
212-523-1685
Provider Enumeration Date:
04/23/2015