Provider Demographics
NPI:1295996569
Name:ADVANCED MEDICAL CARE NJ LLC
Entity type:Organization
Organization Name:ADVANCED MEDICAL CARE NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANCHEZ PENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-453-2025
Mailing Address - Street 1:6815 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1807
Mailing Address - Country:US
Mailing Address - Phone:201-453-2025
Mailing Address - Fax:201-453-2029
Practice Address - Street 1:6815 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-1807
Practice Address - Country:US
Practice Address - Phone:201-453-2025
Practice Address - Fax:201-453-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04283700207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0160491Medicaid
NJ120655Medicare PIN