MEDICARE: PREMISE HEALTH OF CONNECTICUT MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1538561832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMISE HEALTH OF CONNECTICUT MEDICAL PC

Provider Business Mailing Address
First Line	:	5500 MARYLAND WAY
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7048
Country	:	US
Telephone Number	:	203-588-8275
Fax Number	:	203-588-6524

Provider Business Practice Location Address
First Line	:	201 TRESSER BLVD BLDG LOBBY
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06901-3432
Country	:	US
Telephone Number	:	203-588-8275
Fax Number	:	203-588-6524

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDWARD WILLIAM SCHWARTZ
Credential	:
Telephone Number	:	844-407-7557

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	03/13/2026

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