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1255625927 NPI number — PREMISE HEALTH OF NEW JERSEY MEDICAL, P.C

NPI Number: 1255625927
Health Care Provider/Practitioner: PREMISE HEALTH OF NEW JERSEY MEDICAL, P.C

Information about “1255625927” NPI (PREMISE HEALTH OF NEW JERSEY MEDICAL, P.C) exists in 1255625927 in HTML format HTML  |  1255625927 in plain Text format TXT  |  1255625927 in PDF (Portable Document Format) PDF  |  1255625927 in an XML format XML  formats.

NPI Number : 1255625927 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255625927",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PREMISE HEALTH OF NEW JERSEY MEDICAL, P.C",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16906 COLLECTION CENTER DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60693-0001",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "908-947-1034",
    "MailingAddressFaxNumber": "908-947-1023",
    "FirstLinePracticeLocationAddress": "1 MILLENNIUM WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BRANCHBURG",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08876-3876",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "908-947-1034",
    "PracticeLocationAddressFaxNumber": "908-947-1023",
    "EnumerationDate": "05/31/2011",
    "LastUpdateDate": "08/23/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LEIZMAN",
    "AuthorizedOfficialFirstName": "JON",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "216-479-9063",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2300X",
        "TaxonomyName": "Primary Care Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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