Provider First Line Business Practice Location Address: 
100 PORT WASHINGTON BLVD
    Provider Second Line Business Practice Location Address: 
NEW YORK CARDIOVASCULAR ANESTHESIOLOGISTS, P.C.
    Provider Business Practice Location Address City Name: 
ROSLYN
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
11576
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
516-627-6624
    Provider Business Practice Location Address Fax Number: 
516-627-3804
    Provider Enumeration Date: 
02/02/2006