Healthcare Provider Details

I. General information

NPI: 1659383602
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: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 STOKES RD BLDG. B10
MEDFORD NJ
08055-2904
US

IV. Provider business mailing address

PO BOX 3001
VOORHEES NJ
08043-0598
US

V. Phone/Fax

Practice location:
  • Phone: 609-654-9112
  • Fax: 609-654-7404
Mailing address:
  • Phone: 856-782-3300
  • Fax: 856-504-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN M TEDESCHI
Title or Position: CEO/CHAIRMAN
Credential: M.D.
Phone: 856-782-3300