Longevity Men's Health Clinic

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

LONGEVITY MEN'S HEALTH CLINIC

Practice address

4100 Olympia Cir Ste 106
Charlottesville, VA 22911-3620

Phone

(434) 260-3306

NPI assigned

Aug 27, 2024

Last updated

Aug 27, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jason Neil Itri, MD, PHD

Title

Owner and Medical Director

Phone

(267) 844-3195

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724716800000",
    "number": "1134953771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 OLYMPIA CIR STE 106",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229113620",
            "telephone_number": "434-260-3306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 OLYMPIA CIR STE 106",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229113620",
            "telephone_number": "434-260-3306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY MEN'S HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-27",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A",
        "authorized_official_last_name": "ITRI",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "NEIL",
        "authorized_official_title_or_position": "OWNER AND MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "267-844-3195",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah M Long, F.N.P
• Kristin L Long, AG-ACNP
• Mia Gabrielle Long
• Todd J Long, M.D.
• Longevity Health Clinic, Inc
• Christine Longley, ANP
• Katarina Alexandria Longoria-Gray, MD
• Anthony Longoria
• Elizabeth S Longwell, AG-ACNP
• Seamus Looby

• Clinic/Center in Charlottesville, VA
• Providers in Charlottesville, VA by specialty
• Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.