Provider First Line Business Practice Location Address: 
585 SCHENECTEDY AVE KINGSBROOK JEWISH MEDICAL CENTER
    Provider Second Line Business Practice Location Address: 
MINKIN 3 PSYCHIATRIC UNIT
    Provider Business Practice Location Address City Name: 
BROOKLYN
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
11203-1891
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
718-604-5070
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/05/2007