Provider Demographics
NPI:1184929903
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:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:1 NEW YORK TIMES PLAZA
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1200
Mailing Address - Country:US
Mailing Address - Phone:718-281-7142
Mailing Address - Fax:718-281-7067
Practice Address - Street 1:1 NEW YORK TIMES PLZ
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1200
Practice Address - Country:US
Practice Address - Phone:718-281-7142
Practice Address - Fax:718-281-7067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine