1134834369 NPI number — ANGELA ARNOLD ROSS MS, LCGC

Table of content: ANGELA ARNOLD ROSS MS, LCGC (NPI 1134834369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134834369 NPI number — ANGELA ARNOLD ROSS MS, LCGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
ANGELA
Provider Middle Name:
ARNOLD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LCGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARNOLD
Provider Other First Name:
ANGELA
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LCGC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1134834369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 CARLOUGH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER SADDLE RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07458-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-934-0675
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 CARLOUGH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER SADDLE RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07458-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-934-0675
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X , with the licence number:  25MJ00029500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25MJ00029500 . This is a "GENETIC COUNSELING ADVISORY COMMITTEE LICENCE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".