Provider Demographics
NPI:1386824456
Name:ADVANCED CARE OB GYN LLC
Entity Type:Organization
Organization Name:ADVANCED CARE OB GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CARFAGNO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:609-272-0506
Mailing Address - Street 1:707 WHITE HORSE PIKE
Mailing Address - Street 2:SUITE D-4
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201-1458
Mailing Address - Country:US
Mailing Address - Phone:609-272-0506
Mailing Address - Fax:609-272-0607
Practice Address - Street 1:707 WHITE HORSE PIKE
Practice Address - Street 2:SUITE D-4
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-1458
Practice Address - Country:US
Practice Address - Phone:609-272-0506
Practice Address - Fax:609-272-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB065050207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8236208Medicaid
NJ8236208Medicaid