Provider Demographics
NPI:1346662285
Name:PREMISE HEALTH OF NEW YORK MEDICAL, P.C
Entity Type:Organization
Organization Name:PREMISE HEALTH OF NEW YORK MEDICAL, P.C
Other - Org Name:NOMURA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-479-9063
Mailing Address - Street 1:5500 MARYLAND WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4993
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 W 49TH ST
Practice Address - Street 2:28TH FLOOR WORLDWIDE PLAZA
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7316
Practice Address - Country:US
Practice Address - Phone:212-436-8222
Practice Address - Fax:212-436-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center