Provider First Line Business Practice Location Address:
100 PORT WASHINGTON BLVD.
Provider Second Line Business Practice Location Address:
DEPT. OF EMERGENCY MEDICINE
Provider Business Practice Location Address City Name:
ROSLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11576-1353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-686-7654
Provider Business Practice Location Address Fax Number:
631-686-7653
Provider Enumeration Date:
10/06/2006