| Premise Health Of New York Medical, P.c | |
|
4720 Baker Street Ext Lakewood NY 14750-9772 | |
| (716) 456-2334 | |
| (716) 456-2628 |
| Full Name | Premise Health Of New York Medical, P.c |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 4720 Baker Street Ext, Lakewood, New York |
| Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premise Health Of New York Medical, P.c 5500 Maryland Way Ste 120 Brentwood TN 37027-4993 Ph: () - | Premise Health Of New York Medical, P.c 4720 Baker Street Ext Lakewood NY 14750-9772 Ph: (716) 456-2334 |
| NPI Number | 1093991598 |
|---|---|
| Provider Enumeration Date | 01/14/2008 |
| Last Update Date | 08/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093991598 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Lakeside Medical Practice Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 133 Fairmount Avenue, Lakewood, NY 14750 Phone: 716-526-1183 Fax: 716-526-1165 |