Provider Demographics
NPI:1013298702
Name:ADVOCARE PREMIER OB/GYN OF SOUTH JERSEY
Entity Type:Organization
Organization Name:ADVOCARE PREMIER OB/GYN OF SOUTH JERSEY
Other - Org Name:ADVOCARE PREMIER OB/GYN OF SOUTH JERSEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-872-7052
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 1:903 SHEPPARD RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4695
Practice Address - Country:US
Practice Address - Phone:856-772-2300
Practice Address - Fax:856-772-2301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOCARE , LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-08
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077356Medicare Oscar/Certification