1659383602 NPI number — ADVOCARE, LLC

Table of content: (NPI 1659383602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659383602 NPI number — ADVOCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVOCARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVOCARE MEDFORD PEDS & ADOLESCENT MED
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659383602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3001
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-0598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-782-3300
Provider Business Mailing Address Fax Number:
856-504-8029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 STOKES RD
Provider Second Line Business Practice Location Address:
BLDG. B10
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08055-2904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-654-9112
Provider Business Practice Location Address Fax Number:
609-654-7404
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TEDESCHI
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO/CHAIRMAN
Authorized Official Telephone Number:
856-782-3300

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080A0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31D1105569 . This is a "ADVOCARE MEDFORD PEDIATRIC AND ADOLESCENT MEDICINE- CLIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31D0118785 . This is a "ADVOCARE MEDFORD PEDIATRIC AND ADOLESCENT MEDICINE- CLIA" identifier . This identifiers is of the category "OTHER".




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