Provider Demographics
NPI:1689003824
Name:ADVANCED MEDICAL CARE GROUP LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAMATO-PANTANO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:201-952-8411
Mailing Address - Street 1:125 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07206-1792
Mailing Address - Country:US
Mailing Address - Phone:201-952-8411
Mailing Address - Fax:
Practice Address - Street 1:125 1ST ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206-1792
Practice Address - Country:US
Practice Address - Phone:201-952-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00465100363LA2200X
NJ26NJ00430500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty