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General NPI Number Information
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NPI Number | 1033486568
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF NEW YORK MEDICAL, P.C
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 240 GREENWICH STREET
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City | NEW YORK
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State | NY
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Zip | 10286-2550
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Country | US
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Telephone | 212-815-4910
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Fax | 212-815-3352
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Provider Business Mailing Address
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Address Line | 5500 MARYLAND WAY
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City | BRENTWOOD
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State | TN
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Zip | 37027-7048
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JON LEIZMAN
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Credential | MD
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Telephone | 216-479-9063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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