Provider Demographics
NPI:1881062420
Name:Y MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:Y MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:GEISSER
Authorized Official - Suffix:
Authorized Official - Credentials:ESQUIRE
Authorized Official - Phone:954-368-0888
Mailing Address - Street 1:915 MIDDLE RIVER DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3544
Mailing Address - Country:US
Mailing Address - Phone:954-368-0888
Mailing Address - Fax:954-212-2227
Practice Address - Street 1:915 MIDDLE RIVER DR
Practice Address - Street 2:SUITE 114
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3544
Practice Address - Country:US
Practice Address - Phone:954-368-0888
Practice Address - Fax:954-212-2227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAP TO HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty