Organization
IMAGINE MEDICAL GROUP, PA
Active
Organization
IMAGINE MEDICAL GROUP, PA
Active
Other names
Innovatel Medical
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT WILSON MD (PRESIDENT)
(814) 392-8679
Entity
Organization
Contact information
Practice address
100 S JUNIPER ST FL 3, PHILADELPHIA, PA 19107-1316
(267) 999-9534
Mailing address
228 PARK AVE S, NEW YORK, NY 10003-1502
(267) 999-9534
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
04/20/2022
Last updated
10/24/2024
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