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General NPI Number Information
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NPI Number | 1235097064
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Entity Type | Organization
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Legal Business Name | YOUTHOLOGY MEDICAL
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 900 WALT WHITMAN RD STE 205
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City | MELVILLE
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State | NY
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Zip | 11747-2215
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Country | US
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Telephone | 516-817-6423
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Fax |
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Provider Business Mailing Address
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Address Line | 900 WALT WHITMAN RD STE 205
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City | MELVILLE
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State | NY
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Zip | 11747-2215
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Country | US
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Telephone | 516-817-6423
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CRAIG R GROBMAN
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Credential | MD
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Telephone | 516-521-7486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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