Healthcare Provider Details

I. General information

NPI: 1366780587
Provider Name (Legal Business Name): PREMISE HEALTH OF NEW YORK MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 LEXINGTON AVE FL LL2
NEW YORK NY
10022-1346
US

IV. Provider business mailing address

5500 MARYLAND WAY STE 120
BRENTWOOD TN
37027-4993
US

V. Phone/Fax

Practice location:
  • Phone: 212-617-1183
  • Fax: 212-617-9819
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWARD WILLIAM SCHWARTZ
Title or Position: PRESIDENT
Credential:
Phone: 844-407-7557