Organization
ADVOCARE, LLC
Active
Parent organization
ADVOCARE, LLC
Other names
Advocare Medford Peds & Adolescent Med
Organization subpart
Yes
Provider details
NPI number
Legal business name
ADVOCARE, LLC
Authorized official
DR. JOHN M TEDESCHI M.D. (CEO/CHAIRMAN)
(856) 782-3300
Entity
Organization
Contact information
Practice address
520 STOKES RD, BLDG. B10, MEDFORD, NJ 08055-2904
(609) 654-9112
(609) 654-7404
Mailing address
PO BOX 3001, VOORHEES, NJ 08043-0598
(856) 782-3300
(856) 504-8029
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31D0118785
ADVOCARE MEDFORD PEDIATRIC AND ADOLESCENT MEDICINE- CLIA
—
01
—
31D1105569
ADVOCARE MEDFORD PEDIATRIC AND ADOLESCENT MEDICINE- CLIA
—
Enumeration date
08/11/2006
Last updated
08/26/2014
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