Provider First Line Business Practice Location Address:
ONE GUSTAVE L. LEVY PLACE BOX 1230
Provider Second Line Business Practice Location Address:
ICAHN SCHOOL OF MEDICINE DEPARTMENT OF PSYCHIATRY
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-6504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-659-8734
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2014