NPIMap

Organization Active NPI

Premise Health of New Jersey Medical, P.C

  • Occupational Medicine Clinic/Center
  • Wayne, NJ
National Provider Identifier
1679164024
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
Legal business name
PREMISE HEALTH OF NEW JERSEY MEDICAL, P.C
Doing business as
BAE Systems Wayne NJ
Practice address
150 Parish Dr
Wayne, NJ 07470-6009
Phone
(973) 305-2633
Fax
(973) 305-2815
NPI assigned
Jan 28, 2021
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
Occupational Medicine Clinic/Center 261QX0100X Primary

Addresses

Primary practice location

150 Parish Dr
Wayne, NJ 07470-6009

Mailing address

5500 Maryland Way Ste 120
Brentwood, TN 37027-4993

Other names 1

  • BAE Systems Wayne NJ Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D1066238Premise Health of New Jersey Medical, PC150 Parish Drive, Wayne, NJ 07470Certificate of waiverMar 19, 2027

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

150 Parish Dr
Wayne, NJ 07470
Phone (973) 305-2633

NPI Registry JSON

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

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661212800000",
    "number": "1679164024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 PARISH DR",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074706009",
            "telephone_number": "973-305-2633",
            "fax_number": "973-305-2815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF NEW JERSEY MEDICAL, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-28",
        "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": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BAE Systems Wayne NJ",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BAE Systems Wayne NJ",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wayne, 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.