Provider Demographics
NPI:1326294273
Name:ADVOCARE
Entity Type:Organization
Organization Name:ADVOCARE
Other - Org Name:ADVOCARE MEDFORD STATION INTERNAL MEDICINE
Other - Org Type:Doing Business As
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:PO BOX 71422
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19176-1422
Mailing Address - Country:US
Mailing Address - Phone:856-872-7055
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:69 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2718
Practice Address - Country:US
Practice Address - Phone:609-953-9000
Practice Address - Fax:609-953-9696
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-12
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
31D0118747OtherCLIA
077356Medicare Oscar/Certification