Healthcare Provider Details

I. General information

NPI: 1184929903
Provider Name (Legal Business Name): PREMISE HEALTH OF NEW YORK MEDICAL, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NEW YORK TIMES PLZ
FLUSHING NY
11354-1200
US

IV. Provider business mailing address

1 NEW YORK TIMES PLAZA
FLUSHING NY
11354-1200
US

V. Phone/Fax

Practice location:
  • Phone: 718-281-7142
  • Fax: 718-281-7067
Mailing address:
  • Phone: 718-281-7142
  • Fax: 718-281-7067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JON LEIZMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 216-479-9063