1730217936 NPI number — ADVOCARE , LLC

Table of content: (NPI 1730217936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730217936 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 VERNON PEDIATRIC AND FAMILY CARE
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:
1730217936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 ROUTE 73 N STE 320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053-3426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-827-4550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 STATE RT 94
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07462-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-827-4550
Provider Business Practice Location Address Fax Number:
973-827-5845
Provider Enumeration Date:
03/01/2007

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: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 31D0110784 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".




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