| Spark Tms Therapeutic Center, Llc | |
|
128 Chestnut St Ste 103 Philadelphia PA 19106-3024 | |
| (484) 278-1616 | |
| (215) 356-1700 |
| Full Name | Spark Tms Therapeutic Center, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 128 Chestnut St Ste 103, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Andrew Peshek (CO-OWNER) |
| Authorized Official Contact | 2673072340 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spark Tms Therapeutic Center, Llc 128 Chestnut St Ste 103 Philadelphia PA 19106-3024 Ph: (484) 278-1616 | Spark Tms Therapeutic Center, Llc 128 Chestnut St Ste 103 Philadelphia PA 19106-3024 Ph: (484) 278-1616 |
| NPI Number | 1982172094 |
|---|---|
| Provider Enumeration Date | 11/06/2018 |
| Last Update Date | 04/12/2023 |
| Certification Date | 04/12/2023 |
| Medicare PECOS PAC ID | 3072999788 |
|---|---|
| Medicare Enrollment ID | O20221004002169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982172094 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Andrew Donald Peshek |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255451654 PECOS PAC ID: 2860400223 Enrollment ID: I20060327000270 |
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