MEDICARE: ADVANCED MEDICAL CARE NJ LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	25MA04283700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295996569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL CARE NJ LLC

Provider Business Mailing Address
First Line	:	6815 BERGENLINE AVE
Second Line	:
City	:	GUTTENBERG
State	:	NJ
Zip	:	07093-1807
Country	:	US
Telephone Number	:	201-453-2025
Fax Number	:	201-453-2029

Provider Business Practice Location Address
First Line	:	6815 BERGENLINE AVE
Second Line	:
City	:	GUTTENBERG
State	:	NJ
Zip	:	07093-1807
Country	:	US
Telephone Number	:	201-453-2025
Fax Number	:	201-453-2029

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE R SANCHEZ PENA
Credential	:	MD
Telephone Number	:	201-453-2025

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	06/19/2008

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