Organization
PREMISE HEALTH OF CONNECTICUT MEDICAL, P.C.
Active
Other names
BAE Systems-Manchester
Organization subpart
No
Provider details
NPI number
Authorized official
JON LEIZMAN (PRESIDENT)
(216) 479-9063
Entity
Organization
Contact information
Practice address
3000 GOFFS FALLS RD, MANCHESTER, NH 03103-6109
(603) 506-0203
(603) 506-0204
Mailing address
5500 MARYLAND WAY, BRENTWOOD, TN 37027-7048
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/07/2021
Last updated
08/15/2022
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