Healthcare Provider Details

I. General information

NPI: 1770499691
Provider Name (Legal Business Name): CAREVANTAGE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LYONS AVE
NEWARK NJ
07112-2420
US

IV. Provider business mailing address

19 LYONS AVE
NEWARK NJ
07112-2420
US

V. Phone/Fax

Practice location:
  • Phone: 646-529-1200
  • Fax: 862-682-6582
Mailing address:
  • Phone: 646-529-1200
  • Fax: 862-682-6582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL

VIII. Authorized Official

Name: SULIAT ASHAOLU ADESUNBO
Title or Position: OWER
Credential:
Phone: 646-529-1200