Healthcare Provider Details

I. General information

NPI: 1861968216
Provider Name (Legal Business Name): ADVOCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 W ENGLEWOOD AVE
TEANECK NJ
07666-2939
US

IV. Provider business mailing address

629 W ENGLEWOOD AVE
TEANECK NJ
07666-2939
US

V. Phone/Fax

Practice location:
  • Phone: 201-836-4777
  • Fax: 201-606-8236
Mailing address:
  • Phone: 201-836-4777
  • Fax: 201-606-8236

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:

VIII. Authorized Official

Name: CHARLES MCQUEARY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 856-872-7055