Healthcare Provider Details

I. General information

NPI: 1346251428
Provider Name (Legal Business Name): ADVOCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WHITE HORSE PIKE
HADDON HEIGHTS NJ
08035-1909
US

IV. Provider business mailing address

PO BOX 71422
PHILADELPHIA PA
19176-1422
US

V. Phone/Fax

Practice location:
  • Phone: 856-547-7300
  • Fax: 856-547-4573
Mailing address:
  • Phone: 856-872-7055
  • Fax: 856-504-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier31D0118010
Identifier TypeOTHER
Identifier State
Identifier IssuerCLIA

VIII. Authorized Official

Name: CHARLES MCQUEARY
Title or Position: CEO
Credential:
Phone: 856-872-7052