Organization
PREMISE HEALTH OF PENNSYLVANIA MEDICAL, P.C
Active
Other names
Adidas Wilkes-Barre Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
JON LEIZMAN MD (PRESIDENT)
(615) 468-6270
Entity
Organization
Contact information
Practice address
550 NEW COMMERCE BLVD, HANOVER TOWNSHIP, PA 18706-1404
(615) 468-3188
Mailing address
5500 MARYLAND WAY STE 120, BRENTWOOD, TN 37027-4993
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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