Provider Demographics
NPI:1003978347
Name:ADVANCED CARE INTERNAL MEDICINE L.L.C.
Entity Type:Organization
Organization Name:ADVANCED CARE INTERNAL MEDICINE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:NICOLAS
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-900-0471
Mailing Address - Street 1:751 GARNET LN
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8495
Mailing Address - Country:US
Mailing Address - Phone:973-900-0471
Mailing Address - Fax:570-730-4415
Practice Address - Street 1:751 GARNET LN
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8495
Practice Address - Country:US
Practice Address - Phone:973-900-0471
Practice Address - Fax:570-730-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA060596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG15860Medicare UPIN