=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245680305
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVOCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2016
-----------------------------------------------------
Last Update Date | 11/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 195 COLUMBIA TPKE SUITE 105
-----------------------------------------------------
City | FLORHAM PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07932-2254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-437-8300
-----------------------------------------------------
Fax | 973-845-2883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 ROUTE 73 N STE 320
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-3426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-872-7055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DAWN M CANDIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-872-7053
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------