Healthcare Provider Details

I. General information

NPI: 1013060086
Provider Name (Legal Business Name): ADVOCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 NEWTON SPARTA RD
NEWTON NJ
07860-2773
US

IV. Provider business mailing address

401 ROUTE 73 N STE 320
MARLTON NJ
08053-3426
US

V. Phone/Fax

Practice location:
  • Phone: 973-383-9841
  • Fax: 973-383-7989
Mailing address:
  • Phone: 856-872-7055
  • Fax:

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
Identifier0151262
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier31D0115763
Identifier TypeOTHER
Identifier State
Identifier IssuerCLIA

VIII. Authorized Official

Name: CHARLES MCQUEARY
Title or Position: EXECUTIVE VICE PRESIDENT AND COO
Credential:
Phone: 856-872-7055