Provider Demographics
NPI:1619221546
Name:ADVANCED MEDICAL CARE CENTER, PC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWADROUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-752-1000
Mailing Address - Street 1:44 MILFORD CIR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4776
Mailing Address - Country:US
Mailing Address - Phone:732-752-1000
Mailing Address - Fax:732-752-1555
Practice Address - Street 1:1527 ROUTE 27
Practice Address - Street 2:STE 1100
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-752-1000
Practice Address - Fax:732-752-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA078424002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty