Provider Demographics
NPI:1730217936
Name:ADVOCARE , LLC
Entity type:Organization
Organization Name:ADVOCARE , LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TEDESCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-782-3300
Mailing Address - Street 1:401 ROUTE 73 N STE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3426
Mailing Address - Country:US
Mailing Address - Phone:973-827-4550
Mailing Address - Fax:
Practice Address - Street 1:249 STATE RT 94
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462-3327
Practice Address - Country:US
Practice Address - Phone:973-827-4550
Practice Address - Fax:973-827-5845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOCARE , LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
31D0110784OtherCLIA
31D0110784OtherCLIA