PREMISE HEALTH OF MASSACHUSETTS MEDICAL PC NPI 1356781389

NPI Information

PREMISE HEALTH OF MASSACHUSETTS, MEDICAL PC is a general practice in Boston, MA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee PREMISE HEALTH OF MASSACHUSETTS, MEDICAL PC NPI is 1356781389. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Liberty Health Center.

The provider's business location address is:

175 BERKELEY ST
BOSTON, MA
ZIP 02116-066
Phone: (857) 224-9355
Fax: (857) 224-9300

The provider's authorized official is Jon Leizman .
The authorized official title is President and has the following contact phone number (216) 479-9063.

The CLIA number assigned to this NPI record is 22D2061989 - other - corporate health with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/5/2013 and was last updated on 8/24/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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