NPIMap

Organization Active NPI

Premise Health of New Jersey Medical, P.C

  • Multi-Specialty Clinic/Center
  • Jersey City, NJ
National Provider Identifier
1033624440
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMISE HEALTH OF NEW JERSEY MEDICAL, P.C
Practice address
30 Hudson St FL 30
Jersey City, NJ 07302-4600
Phone
(201) 942-2200
Fax
(201) 685-6702
NPI assigned
Dec 7, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jon Leizman, MD
Title
President
Phone
(216) 479-9063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

30 Hudson St FL 30
Jersey City, NJ 07302-4600

Mailing address

5500 Maryland Way Ste 400
Brentwood, TN 37027-7048
Phone (844) 407-7557

Other names 1

  • NYL Wellness Center Jersey City Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of New Jersey Medical PC31 organizations share this tax ID, including this one

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

Locations

30 Hudson St
Fl 30
Jersey City, NJ 07302
Phone (201) 942-2200

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661212800000",
    "number": "1033624440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 400",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277048",
            "telephone_number": "844-407-7557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 HUDSON ST FL 30",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073024600",
            "telephone_number": "201-942-2200",
            "fax_number": "201-685-6702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF NEW JERSEY MEDICAL, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-07",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NYL Wellness Center Jersey City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jersey City, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.