Provider First Line Business Practice Location Address:
1190 FIFTH AVENUE
Provider Second Line Business Practice Location Address:
MOUNT SINAI MEDICAL CENTER
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-6503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-241-9466
Provider Business Practice Location Address Fax Number:
212-659-1521
Provider Enumeration Date:
12/14/2005