Healthcare Provider Details

I. General information

NPI: 1992997894
Provider Name (Legal Business Name): ADVOCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WHITE HORSE RD GLENDALE EXECUTIVE CAMPUS SUITE 802
VOORHEES NJ
08043-4406
US

IV. Provider business mailing address

402 LIPPINCOTT DR
MARLTON NJ
08053-4112
US

V. Phone/Fax

Practice location:
  • Phone: 856-435-0400
  • Fax: 856-435-1448
Mailing address:
  • Phone: 856-782-3300
  • Fax: 856-504-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number25MA05933700
License Number StateNJ

VIII. Authorized Official

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