Provider Demographics
NPI:1558421552
Name:ADVANCE CARE OBGYN, LLC
Entity Type:Organization
Organization Name:ADVANCE CARE OBGYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARFAGNO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-927-9495
Mailing Address - Street 1:200 PRANCER RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5937
Mailing Address - Country:US
Mailing Address - Phone:609-927-9495
Mailing Address - Fax:609-927-7328
Practice Address - Street 1:200 PRANCER RD
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5937
Practice Address - Country:US
Practice Address - Phone:609-927-9495
Practice Address - Fax:609-927-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06505000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8236208Medicaid
NJH18462Medicare UPIN
NJ8236208Medicaid