Provider First Line Business Practice Location Address: 
1400 PELHAM PKWY S, JACOBI HOSPITAL, PSYCHIATRY
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
BRONX
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
10461
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
212-939-2291
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/02/2020