Healthcare Provider Details

I. General information

NPI: 1255181491
Provider Name (Legal Business Name): SPARK PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 5TH AVENUE, FLOOR 11
NEW YORK NY
10001
US

IV. Provider business mailing address

220 5TH AVE FL 11
NEW YORK NY
10001-8017
US

V. Phone/Fax

Practice location:
  • Phone: 914-266-0524
  • Fax:
Mailing address:
  • Phone: 914-266-0524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHANG WANG
Title or Position: OWNER
Credential: MD
Phone: 914-266-0524