| Innovatel Medical | |
|
100 S Juniper St Fl 3 Philadelphia PA 19107-1316 | |
| (267) 999-9534 | |
| Not Available |
| Full Name | Innovatel Medical |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 100 S Juniper St Fl 3, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Robert Wilson (PRESIDENT) |
| Authorized Official Contact | 8143928679 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovatel Medical 228 Park Ave S New York NY 10003-1502 Ph: (267) 999-9534 | Innovatel Medical 100 S Juniper St Fl 3 Philadelphia PA 19107-1316 Ph: (267) 999-9534 |
| NPI Number | 1821731548 |
|---|---|
| Provider Enumeration Date | 04/20/2022 |
| Last Update Date | 10/24/2024 |
| Certification Date | 10/24/2024 |
| Medicare PECOS PAC ID | 5698154086 |
|---|---|
| Medicare Enrollment ID | O20220615000283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821731548 | NPI | - | NPPES |
| Provider Name | Susan M Plucknett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356537294 PECOS PAC ID: 5597845487 Enrollment ID: I20080104000279 |
| Provider Name | Kevin Carl |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144459124 PECOS PAC ID: 4981844024 Enrollment ID: I20130712000340 |
| Provider Name | Amanda S Adamczyk |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073064135 PECOS PAC ID: 3971845983 Enrollment ID: I20190423001391 |
| Provider Name | Stefany Diaz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790070373 PECOS PAC ID: 2961723796 Enrollment ID: I20200305000258 |
| Provider Name | Christopher Marshall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184070336 PECOS PAC ID: 7113306515 Enrollment ID: I20220615000781 |
| Provider Name | Tammy Jo Rodgers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043768468 PECOS PAC ID: 6002289774 Enrollment ID: I20230228000390 |
| Provider Name | Lauren Pearson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669510319 PECOS PAC ID: 8224115753 Enrollment ID: I20230710000232 |
| Provider Name | Allyson Roudybush |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568157600 PECOS PAC ID: 1355701988 Enrollment ID: I20230714000997 |
| Provider Name | Janet Pedroza Ramos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942852207 PECOS PAC ID: 9931537420 Enrollment ID: I20230714002643 |
| Provider Name | Christopher T Dennis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225440084 PECOS PAC ID: 9436535598 Enrollment ID: I20230725000133 |
| Provider Name | Sarah Hairston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598364200 PECOS PAC ID: 5597126797 Enrollment ID: I20230803004570 |
| Provider Name | Jeremy Robichaud |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740792340 PECOS PAC ID: 9335566785 Enrollment ID: I20230818001498 |
| Provider Name | Tiffany Terry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194356600 PECOS PAC ID: 8628407715 Enrollment ID: I20230918003432 |
| Provider Name | Maria Lamas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427425826 PECOS PAC ID: 9133576481 Enrollment ID: I20231108003255 |
| Provider Name | Rachael Romesberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225522964 PECOS PAC ID: 0345691770 Enrollment ID: I20240110000056 |
| Provider Name | Jeffrey Klemann |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255464517 PECOS PAC ID: 2163327958 Enrollment ID: I20240413000274 |
| Provider Name | Alexandria Evans |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740619287 PECOS PAC ID: 5193101848 Enrollment ID: I20240415001905 |
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