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General NPI Number Information
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NPI Number | 1255625927
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF NEW JERSEY MEDICAL, P.C
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 1 MILLENNIUM WAY
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City | BRANCHBURG
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State | NJ
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Zip | 08876-3876
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Country | US
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Telephone | 908-947-1034
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Fax | 908-947-1023
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Provider Business Mailing Address
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Address Line | 16906 COLLECTION CENTER DR
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City | CHICAGO
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State | IL
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Zip | 60693-0001
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Country | US
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Telephone | 908-947-1034
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Fax | 908-947-1023
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Authorized Official
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Title or Position | PRESIDENT
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Name | JON LEIZMAN
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Credential | M.D.
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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