Provider First Line Business Practice Location Address: 
NYU TISCH HOSPITAL
    Provider Second Line Business Practice Location Address: 
570 FIRST AVENUE
    Provider Business Practice Location Address City Name: 
NEW YORK
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
10016
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
678-451-6115
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/19/2021