Provider Demographics
NPI:1215108956
Name:ADVANCED CARE LLC.
Entity type:Organization
Organization Name:ADVANCED CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRENKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-298-0650
Mailing Address - Street 1:264 AMITY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2200
Mailing Address - Country:US
Mailing Address - Phone:203-298-0650
Mailing Address - Fax:203-298-0973
Practice Address - Street 1:264 AMITY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2200
Practice Address - Country:US
Practice Address - Phone:203-298-0650
Practice Address - Fax:203-298-0973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001374678Medicaid
CT110009929Medicare PIN
CTG60804Medicare UPIN